AHM-520 study materials - AHIP AHM-520 dumps VCE

AHIP AHM-520 : Health Plan Finance and Risk Management

Exam Code: AHM-520

Exam Name: Health Plan Finance and Risk Management

Updated: Sep 04, 2026

Q & A: 215 Questions and Answers

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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 Syllabus Topics:

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

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