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Exam Information
Official specifications published by AHIP
Exam Format
120 min
75
70%
Professional
Registration
$280 USD
Online Proctored or online proctoring
English
Validity
3 years
Retake the exam; Complete continuing education credits through AHIP; Enroll in updated course version
AHM-520 Exam Topics and Domains
AHM-520 is organized into 6 weighted domains. Expect to work with ASO, Medicaid Managed Care, Medicare Advantage, Part D.
1
Reserving Methodologies and Strategic Financial Planning
16.67%
Reserving Methodologies
Types of ReservesReserve Estimation Techniques
- Recognize different reserving methodologies used by health insurance providers
- Apply appropriate reserve estimation techniques to various scenarios
- Calculate reserves using industry-standard methods
Strategic Financial Planning
Long-term Financial StrategyFinancial Forecasting
- Analyze the role of strategic financial planning in setting a health insurance provider's future direction
- Develop comprehensive financial forecasts
- Align financial strategy with organizational goals
2
Medicare and Medicaid Financial Risks
16.67%
Medicare Financial Risks
Medicare Advantage RiskRisk Adjustment Models for Medicare
- Learn about the financial risks for health insurance provider organizations that provide health care services to Medicare populations
- Understand risk adjustment and HCC coding impact on revenue
- Compare Medicare financial risks to commercial population risks
Medicaid Financial Risks
Medicaid Managed Care RiskSpecial Medicaid Populations
- Analyze financial risks for Medicaid populations compared to commercial
- Understand Medicaid rate-setting and risk-sharing mechanisms
- Manage special population financial risks
3
Financial Statement Analysis
16.67%
Health Plan Financial Statements
Balance Sheet ComponentsIncome Statement Analysis
- Discover how to identify claim related components of health insurance providers' financial statements
- Analyze balance sheets for health insurers
- Interpret income statements for health plans
Key Financial Metrics
Medical Loss Ratio (MLR)Other Key Ratios
- Calculate and interpret medical loss ratios
- Apply key financial metrics to evaluate health plan performance
- Understand financial statement users and stakeholders
4
Risk Management and Control
16.67%
Types of Risk
Underwriting RiskOperational and Other Risks
- Gain an understanding of risk and different types of risk in health insurance
- Identify and categorize various risk sources
- Assess risk severity and likelihood
Risk Assumption and Control
Risk Assumption DecisionsRisk Control Mechanisms
- Understand decisions regarding risk assumption
- Learn how health insurance providers control risk
- Apply risk management strategies effectively
5
Funding Models
16.67%
Fully Funded Plans
Fully Insured CharacteristicsFully Funded Financial Implications
- Understand fully funded plan characteristics
- Analyze financial implications of fully funded arrangements
- Compare to self-funded alternatives
Self-Funded Plans
Self-Funded CharacteristicsRole of Self-Funding in Marketplace
- Distinguish between fully funded and self-funded plans
- Understand the increasing role of self-funding in the marketplace
- Analyze financial implications of each funding model
6
Stop-Loss Insurance and Reinsurance
16.67%
Stop-Loss Insurance Fundamentals
Types of Stop-Loss CoverageStop-Loss from Employer Perspective
- Understand stop-loss insurance mechanisms
- Differentiate between stop-loss types
- Analyze stop-loss from employer perspective
Reinsurance from Health Plan Perspective
Health Plan ReinsuranceDifference Between Stop-Loss and Reinsurance
- Compare the difference between stop-loss insurance and stop-loss reinsurance from the perspective of health insurance providers
- Understand premium rate setting for stop-loss and reinsurance
- Analyze coverage limits and structures
How do I earn this certification?
Passing AHM-520 earns the FAHM certification. It sits in the Healthcare Management track.
Current Level Exams
Next Level Options
- ACS - Associate, Customer Service Specialist Customer service specialization in health insurance
- FLMI - Fellow, Life Management Institute Advanced insurance management designation
Alternative Paths
- HIA - Health Insurance Associate Entry-level health insurance designation
- AIRC - Associate in Reinsurance Complementary reinsurance knowledge
Practice with Precision
The PlanetCert Simulator mirrors the real exam environment with authentic questions and timed pressure.
How to study for this exam?
The most effective way to prepare for AHM-520 is by using the PlanetCert Simulator to practice questions and review detailed explanations.
What's changed on this exam?
Current Status
- ACTIVE
- Last content update: 2025
Updates
- Value-Based Care Payment Models Increasing emphasis on risk-sharing arrangements and financial implications
- Social Determinants of Health (SDOH) in Risk Adjustment Emerging consideration in Medicare Advantage risk scoring
Who should take this exam?
- Minimum 2 years experience in health insurance
- Experience in managed care setting preferred
- Working knowledge of MCO operations
- Basic understanding of healthcare finance and economics
- Familiarity with Medicare and Medicaid programs