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

AHM-520 Exam Simulator
  • Exam Code: AHM-520
  • Exam Name: Health Plan Finance and Risk Management
  • Updated: Jul 17, 2026
  • Q & A: 215 Questions and Answers
  • AHIP AHM-520 Q&A - in .pdf

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

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AHIP AHM-520 exam simulator

AHIP AHM-520 Exam Syllabus Topics:

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

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