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AHIP AHM-520 Exam : Health Plan Finance and Risk Management

AHM-520 actual test
  • Exam Code: AHM-520
  • Exam Name: Health Plan Finance and Risk Management
  • Updated: Sep 11, 2026
  • Q & A: 215 Questions and Answers
  • PDF Demo
  • PC Test Engine
  • Online Test Engine
  • Total Price: $59.99  

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Who should take the AHM-520 exam

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

The benefit in Obtaining the AHM-520 Exam Certification

  • By passing the AHM-520 exam will give candidates a sense of personal accomplishment and the respect of colleagues in their organization and throughout the industry.
  • By passing, AHM-520 exam candidate can add a new dimension to his career experience and distinguish himself as a person who is knowledgeable about the environment, products, operations, and issues of the health insurance plan industry.
  • Candidates can learn unique complexities associated with health plans and being the update in knowledge with the latest trends, developments, and practices.
  • By passing in Health Plan Finance and Risk Management AHM-520 Exam, Candidates can be participating in a new and exciting course. Candidate's participation will signify their commitment to professionalism.
  • Candidates can get knowledge and skills that help them to succeed in the rapidly changing and evolving healthcare industry.

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

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AHIP AHM-520 Exam Syllabus Topics:

SectionObjectives
Risk Management in Health Plans- Utilization and cost control strategies
  • 1. Managed care cost containment tools
    • 2. Provider reimbursement models (capitation, FFS, bundled payments)
      - Insurance risk concepts
      • 1. Risk pooling and transfer mechanisms
        • 2. Underwriting principles in managed care
          Health Plan Financial Fundamentals- Cost accounting in health plans
          • 1. Administrative vs medical expense allocation
            • 2. Medical cost classification
              - Health insurance revenue streams and premium structures
              • 1. Membership and enrollment impact on revenue
                • 2. Premium development basics
                  Health Plan Payment and Reimbursement Systems- Value-based payment models
                  • 1. Pay-for-performance programs
                    • 2. Shared savings models
                      - Provider payment methodologies
                      • 1. Fee-for-service reimbursement
                        • 2. Capitation and risk adjustment basics

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