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Updated: Jul 30, 2026

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AHIP AHM-520 Exam Overview:

Certification Vendor:AHIP
Exam Name:Health Plan Finance and Risk Management
Exam Number:AHM-520
Available Languages:English
Exam Format:Multiple-choice (computer-based)
Related Certifications:AHIP AHM 510
AHIP AHM 540
Sample Questions:AHIP AHM-520 Sample Questions
Exam Way:Online or proctored computer-based exam (varies by provider delivery method)
Pre Condition:No formal prerequisite; basic understanding of health insurance concepts recommended.

For more info visit:

AHM-520 Exam Reference

Certification Path

The Health Plan Finance and Risk Management AHM-520 Exam certification path includes only one AHM-520 certification exam.

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

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:

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

AHIP AHM-520 Exam Syllabus Topics:

SectionObjectives
Topic 1: Health Plan Financial Fundamentals- Health insurance revenue streams and premium structures
  • 1. Membership and enrollment impact on revenue
    • 2. Premium development basics
      - Cost accounting in health plans
      • 1. Administrative vs medical expense allocation
        • 2. Medical cost classification
          Topic 2: Health Plan Payment and Reimbursement Systems- Value-based payment models
          • 1. Shared savings models
            • 2. Pay-for-performance programs
              - Provider payment methodologies
              • 1. Fee-for-service reimbursement
                • 2. Capitation and risk adjustment basics
                  Topic 3: Risk Management in Health Plans- Insurance risk concepts
                  • 1. Risk pooling and transfer mechanisms
                    • 2. Underwriting principles in managed care
                      - Utilization and cost control strategies
                      • 1. Provider reimbursement models (capitation, FFS, bundled payments)
                        • 2. Managed care cost containment tools

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