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AHIP AHM-520 - Health Plan Finance and Risk Management

Updated: Aug 11, 2026

Q & A: 215 Questions and Answers

AHM-520 Braindumps VCE
  • Exam Code: AHM-520
  • Exam Name: Health Plan Finance and Risk Management

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Who should take the AHM-520 exam

  • Teachers at the school level who teach health care administration
  • Employees who work for health care providers or health insurance plans and want to get the educational background to proceed with a management position in the industry
  • Medical management employees working in hospitals, health systems, and, health insurance plans
  • Agents and brokers who expert in life and health insurance
  • Case administrators and medical directors who inquire a broader administrative background
  • Financial executives working with clients looking to maximize their health dollars

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AHM-520 Exam Reference

Reference: https://www.ahip.org/courses/health-plan-finance-and-risk-management-ahm520

What is the duration of the AHM-520 Exam

  • Length of Examination: 90 minutes
  • Format: Multiple choices, multiple answers
  • Number of Questions: 215

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AHIP AHM-520 Exam Syllabus Topics:

SectionObjectives
Topic 1: Regulatory and Compliance Framework- Healthcare regulations
  • 1. Affordable Care Act requirements
    • 2. State insurance regulations
      - Governance and reporting
      • 1. Regulatory reporting
        • 2. Compliance oversight
          Topic 2: Claims Analysis and Utilization Management- Utilization management
          • 1. Cost containment strategies
            • 2. Efficiency improvement
              - Claims data analysis
              • 1. Trend analysis
                • 2. Cost drivers
                  Topic 3: Provider Payment Models- Traditional and alternative reimbursement
                  • 1. Fee-for-service
                    • 2. Capitation
                      - Value-based payment
                      • 1. Financial incentives and provider risk
                        • 2. Shared savings arrangements
                          Topic 4: Health Plan Financial Structures- Financial reporting
                          • 1. Performance measurement
                            • 2. Financial statements
                              - Revenue sources and premium development
                              • 1. Premium setting principles
                                • 2. Administrative and medical cost allocation
                                  Topic 5: Medical Loss Ratio and Compliance- Compliance requirements
                                  • 1. Reporting obligations
                                    • 2. Rebate requirements
                                      - Medical Loss Ratio concepts
                                      • 1. MLR calculation
                                        • 2. Regulatory thresholds
                                          Topic 6: Actuarial Principles and Forecasting- Forecasting methods
                                          • 1. Scenario modeling
                                            • 2. Financial planning
                                              - Actuarial concepts
                                              • 1. Cost projection
                                                • 2. Reserve estimation
                                                  Topic 7: Risk Assessment and Risk Management- Risk mitigation strategies
                                                  • 1. Predictive modeling
                                                    • 2. Risk adjustment
                                                      - Risk identification and evaluation
                                                      • 1. Insurance risk
                                                        • 2. Operational and financial risk

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