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Health Plan Finance and Risk Management AHM-520 Exam is designed by the Academy of Health Care Administration (AHM) and sponsored by the US Health Insurance Plans and the Blue Cross Blue Shield Association. AHM is a self-study examination based program. AHM-520 Exam validates candidate has the ability to get a comprehensive look at the Health Insurance Plan Fund. This exam also verifies the candidate has a strong understanding of financial management techniques, funds, risk management, provider payment, project risk, pricing, care, and rating methods.
Reference: https://www.ahip.org/courses/health-plan-finance-and-risk-management-ahm520
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| Section | Objectives |
|---|---|
| Topic 1: Medical Loss Ratio and Compliance | - Medical Loss Ratio concepts
|
| Topic 2: Risk Assessment and Risk Management | - Risk identification and evaluation
|
| Topic 3: Claims Analysis and Utilization Management | - Claims data analysis
|
| Topic 4: Regulatory and Compliance Framework | - Healthcare regulations
|
| Topic 5: Actuarial Principles and Forecasting | - Actuarial concepts
|
| Topic 6: Health Plan Financial Structures | - Financial reporting
|
| Topic 7: Provider Payment Models | - Value-based payment
|
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