Health Insurance Management (HINX)

This course provides a comprehensive overview of health insurance history, marketplace, principles, laws, regulations, and practices. Topics covered include government programs, reimbursement and payment methodologies, provider networks, community versus experience rating, ethical considerations, risk assessment, and emerging trends in the health insurance industry. The course aims to equip students with the knowledge and skills necessary to navigate the complex world of health insurance.

This course provides a comprehensive overview of the inner workings of modern health insurance carriers. Students will examine critical functions that drive health insurance companies, including product development, legal implications, finance and risk assessment, provider contracting, claims operations, compliance, provider relations, and customer experience management. Students will learn how departments interconnect to maintain profitability while meeting regulatory requirements. Through real-world examples and case studies, students will gain practical insights into how health insurance companies maintain operational efficiency. Upon completion, students will understand both the strategic and day-to-day operational decisions that shape competitive health insurance organizations.

This course provides an in-depth exploration of the legal and regulatory frameworks governing health insurance in the United States. Students will examine the historical development of health insurance, key legislative acts, and the roles of federal and state agencies in regulating health insurance markets. Topics include managed care principles, Affordable Care Act, Medicaid, Medicare, ERISA and employer-sponsored insurance, and supplemental health insurance. The course will also cover current issues such as health care reform, fundamentals of insurance, and the impact of legal decisions on health policy.

This course provides an in-depth exploration of the essential skills required for medical billing and coding. Students will develop a thorough understanding of the healthcare billing cycle and various diagnostic and procedural coding systems. Students will learn the importance of accuracy and compliance in billing processes, the impact of reimbursement methodologies, and the legal aspects of healthcare billing. Students will be equipped with the knowledge and skills necessary to navigate the complexities of medical billing and coding, preparing them for careers in healthcare insurance management.

This course examines key topics in prospective payment systems (PPS) and value-based healthcare (VBHC), including the fundamentals of healthcare payment models, risk adjustment, and quality measures that drive value-based care, alongside regulatory and policy frameworks. Through theoretical applications and practical case studies, students will learn to assess the impact of various payment models on healthcare providers and patient outcomes, gaining skills in evaluating cost-control strategies, understanding quality improvement incentives, and exploring future trends and innovations in healthcare reimbursement.

This is the capstone course in the Health Insurance Management program. Students apply knowledge and skills acquired in the program to a complex problem or issue. The course emphasizes practical application of core competencies in provider relations, health informatics, provider contracting, claims/reimbursement, and quality improvement. Students will complete a comprehensive capstone project that demonstrates their ability to integrate multiple aspects of health insurance management while showcasing leadership, critical thinking, and problem-solving skills.