Health Plan Finance and Risk Management: AHM-520 Exam

"Health Plan Finance and Risk Management", also known as AHM-520 exam, is a AHIP Certification. With the complete collection of questions and answers, BraindumpsPass has assembled to take you through 215 Q&As to your AHM-520 Exam preparation. In the AHM-520 exam resources, you will cover every field and category in AHIP Certification Certification helping to ready you for your successful AHIP Certification.

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  • Exam Code: AHM-520
  • Exam Name: Health Plan Finance and Risk Management
  • Certification Provider: AHIP
  • Corresponding Certification: AHIP Certification
  • Updated: Sep 17, 2026
  • No. of Questions: 215 Questions & Answers with Testing Engine
  • Download Limit: Unlimited

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AHM-520 Exam topics

Candidates must know the exam topics before they start of preparation. Because it will really help them in hitting the core. Our AHM-520 exam dumps will include the following topics:

  • Different Types of risks health plans face and approaches they use to manage them.
  • Factors of health plans consider when developing and pricing healthcare products.
  • Fundamental accounting principles associated with a health plan's financial information.
  • Main risks and cost factors associated with the delivery and financing of health-care services under Medicare and Medicaid contracts.
  • Differences between fully funded and self-funded health plans.
  • Methods to use financial information to develop a health plan's strategic plan and manage the health plan's cash and capital effectively.
  • Method of analyzing and interpreting the results of a health plan's financial statements through the use of financial ratios.
  • Important factors and methods associated with underwriting and rating healthcare benefits.

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How to study the AHM-520 Exam

BraindumpsPass expert team recommends you to prepare some notes on these topics along with it don't forget to practice Health Plan Finance and Risk Management AHM-520 Exam which been written by our expert team, Both these will help you a lot to clear this exam with good marks.

Who should take the AHM-520 exam

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

For more info visit:

AHM-520 Exam Reference

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

AHIP AHM-520 Exam Syllabus Topics:

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

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