Nationally Certified Multi-Skilled Insurance and Reimbursement Specialist
CIP Code: 51.0709 • 125 questions • 2.5 hours • Passing score: 70% • Annual renewal
Overview
This credential validates multi-skilled readiness across the healthcare revenue cycle: insurance verification, prior authorization, benefits coordination, claims submission, denials and appeals, and patient financial communication. Certified specialists understand payer policies, documentation integrity, and compliant reimbursement workflows.
- Nationally recognized Multi-Skilled Stackable
- Listed in the NHWCA National Registry for employer verification
- Annual renewal: 10 CEU, No lapse (CPR not required)
Why Multi-Skilled?
NHWCA’s multi-skilled model verifies cross-functional competency across insurance verification, prior authorization, claims, denials, and compliant reimbursement—so one specialist can support both front-end access and back-end collections with fewer handoffs.
Job Description
An Insurance and Reimbursement Specialist coordinates eligibility and benefits, obtains authorizations, prepares and submits claims, resolves denials and appeals, communicates patient financial responsibility, and collaborates with coding and clinical teams to ensure accurate, timely, and compliant reimbursement.
Qualifications (choose one)
- Graduate of a billing/coding or medical office program; or
- Experience: 3 months insurance, prior auth, or revenue cycle work; or
- AHIMA/AAPC coursework accepted but not required.
All candidates must meet age, ID, and conduct requirements per the NHWCA Candidate Handbook.
Exam Structure & Timing
| Element | Detail |
|---|---|
| Question Count | 125 multiple-choice (100 scored + 25 pilot) |
| Time Limit | 2.5 hours (150 minutes) |
| Passing Score | 70% or higher |
| Delivery | Online or approved testing site, proctored, closed-book |
| Question Style | Scenario-based and knowledge-based items |
Exam Domains & Weighting
| Domain | Weight | Approx. Questions |
|---|---|---|
| Insurance Eligibility, Benefits & Authorizations | 40% | ~50 |
| Claims, Denials & Reimbursement Processes | 40% | ~50 |
| Compliance, Documentation & Patient Financial Communication | 20% | ~25 |
Totals reflect 100 scored items; 25 pilot items do not affect score.
Practice Questions (10)
Included with registration inside the candidate portal. These do not affect your score but mirror the style and depth of the live exam.
Renewal
- Cycle: Annual
- Requirements: 10 CEU, No lapse (CPR not required)
- Fee: $199
© NHWCA – National Healthcare Workers Certification Association. All rights reserved.