• Exam Code: AHM-520
  • Exam Name: Health Plan Finance and Risk Management
  • Certification Provider: AHIP
  • Corresponding Certification:AHIP Certification
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Certification Path

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

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:

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

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

Health Plan Finance and Risk Management AHM-520 Exam

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.

Who should take the AHM-520 exam

  • 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
  • Case administrators and medical directors who inquire a broader administrative background
  • Financial executives working with clients looking to maximize their health dollars
  • 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

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AHIP AHM-520 Exam Syllabus Topics:

SectionObjectives
Topic 1: 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
          Topic 2: Health Plan Payment and Reimbursement Systems- Provider payment methodologies
          • 1. Capitation and risk adjustment basics
            • 2. Fee-for-service reimbursement
              - Value-based payment models
              • 1. Shared savings models
                • 2. Pay-for-performance programs
                  Topic 3: 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

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