AHIP AHM-520 : Health Plan Finance and Risk Management

  • Exam Code: AHM-520
  • Exam Name: Health Plan Finance and Risk Management
  • Updated: Aug 14, 2026
  • Q & A: 215 Questions and Answers

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About AHIP AHM-520 Exam

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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.

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

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These are following steps for registering the AHM-520 exam. Step 1: Visit to AHIP Exam Registration Step 2: Signup/Login to AHIP INSURANCE EDUCATION account Step 3: Search for AHM-520 Exam Certifications Exam Step 4: Select Date, time and confirm with payment method

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What is the duration of the AHM-520 Exam

  • Length of Examination: 90 minutes
  • Number of Questions: 215
  • Format: Multiple choices, multiple answers

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

AHIP AHM-520 Exam Syllabus Topics:

SectionObjectives
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. Pay-for-performance programs
        • 2. Shared savings models
          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
                  Risk Management in Health Plans- Utilization and cost control strategies
                  • 1. Provider reimbursement models (capitation, FFS, bundled payments)
                    • 2. Managed care cost containment tools
                      - Insurance risk concepts
                      • 1. Risk pooling and transfer mechanisms
                        • 2. Underwriting principles in managed care

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