Role Description The RCM Services Advisor I is responsible for managing RCM Service support and communication for our smaller members. It will leverage mass communication technology and work queue management to deliver the liaison and advisory role at scale working to ensure a successful delivery of our RCM services. You will provide solutions to the challenges faced by WebPT RCM members, supporting a primary communication line between members and our RCM Operations Team. What You’ll Be Doing As A Part of Our Team - Member Engagement & Relationship Management: - Serve as the primary point of contact for assigned RCM members, ensuring quality service and member retention. - Build and maintain trust through consistent communication with external members and internal teams. - Send regular emails to member leadership intended to deliver status updates, and insights into member financial results and KPIs. - Participate in development of tech touch campaigns to drive improved member health. - Identify new programs that will enable member value and outcomes in a repeatable and scalable way. - Address inbound client emails through Salesforce/Gainsight queue. - Collaborate with Client Success Manager(s), Product, IT and other applicable departments to ensure Member expectations are met. - Participate in Member meetings as subject matter expert for RCM service offerings. - Leverage available RCM metrics, detect abnormal trends, and work with Members and RCM Operations Team to resolve issues quickly. - Manage member RCM health by tracking key metrics, documenting activities in Salesforce & Gainsight, and escalating issues to prevent client attrition. - Address concerns from NPS (Net Promoter Score) surveys and proactively identify and mitigate churn risks. - Quickly address escalated billing issues by working through RCM Ops communication channels. - Lead the creation and communication of effective corrective action and risk plans. - Advisory & Process Improvement: - Develop sufficient product knowledge to demonstrate billing expertise to our members. - Identify process improvement opportunities and act to resolve through collaboration with internal and external departments. - Work with RCM Operations to identify gaps in standard workflows and obtain member engagement to promote efficient and effective resolutions and improved delivery. - Provide valuable insights to Members based on metric trends, industry benchmarks and payer landscape focused on optimized financial outcomes/NRPV. - Sales Support and New Member Onboarding: - Cultivate reference lists, case studies and testimonials for Sales & Marketing. - Participate in sales transition and implementation calls to understand client needs and expectations. - Ensure any client exceptions from standard best-practice have proper approval and documentation from RCM Operations’ Management. - Provide post go-live training support and ensure clients achieve a healthy status within 90 days. - Additional Responsibilities: - Stay up to date on third-party billing requirements and reimbursement guidelines. - Provide alignment and documentation to RCM Operations on member specific SOP, guideline, or payer rules updates. - Complete special projects and other duties as assigned. - Ensure reliable and punctual attendance. Qualifications - 5 years of experience in full revenue cycle medical billing, preferably in a SaaS environment. - 2 years of experience supporting small to mid-sized practices. - Ability to coordinate many different levels within and across organizations. - Ability to think creatively, desire to try new things and be stellar at interacting with all levels of internal and external organizations. - Empathy for our Members while protecting the interests of our company and its assets. - Working knowledge of Salesforce or other CRM software tools. - Ability to review and analyze data and make recommendations to Members and internal teams. - Ability to maintain focus with interruptions, even in the most stressful of circumstances. - Great customer service skills leveraging excellent communication skills, both written and verbal. - Ability to think logically and process sequentially with a high level of detailed accuracy and efficiency. - Simultaneous management of many complex projects. - General knowledge of medical procedures and terminology and treatment practices and ability to communicate such to others. - Excellent time management skills. Ideally, You Would Also Have These - BA or BS Degree. - 2 years of leadership, account management or sales experience. - Successful track record working with Executive and Financial Teams, clinical teams, RCM, or similar combination. - Physical Therapy billing experience. - Secondary education in healthcare administration or business. Company Description Here, we work hard—but we have lots of fun doing it. We believe in equal opportunity for all, autonomy, trailblazing, and always doing right by our Members. Most importantly, though, we believe in empowering rehab therapy professionals to achieve greatness in practice. So, if you’re a can-do kinda person who loves to help Members win and enjoys working from just about anywhere—then you’ll fit right in. We’ve got big plans, but we can’t achieve them without you. Join us, and let’s achieve greatness. Company Perks - Ample Time Off for fun and rest. - Work from nearly anywhere in the US. - WFH supply budget. - Time Off to make an impact through volunteering. - Multiple Employee Resource Groups (ERGs). - Health, Dental, Vision, 401k, HSA, and many other benefits. Authenticity and Acceptance At WebPT, we're dedicated to fair and competitive compensation based upon our industry peer benchmarks. While job postings offer a pay range as a general reference, the final offer depends on candidate qualifications and experience. Our aim is to provide equitable compensation that recognizes your unique skills and contributions. During interviews, we'll discuss your qualifications and expectations, striving for a competitive and fair offer. The initial hiring range for this position is: $52,300 - $65,400.

Become a part of our caring community The Utilization Management Nurse utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Nurse uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures. Use your skills to make an impact Required Qualifications - Active licensed Registered Nurse (RN) in the state of Virginia or obtain a multi-state license in a state that participates in the enhanced licensure, (eNLC) with no disciplinary action. - At least 2 years prior utilization management experience preferably in an acute care skilled or rehabilitation clinical or healthplan/hospital setting - Intermediate to Advanced knowledge using Microsoft Office Word, Excel, PowerPoint, navigating multiple systems and platforms and ability to troubleshoot and resolve basic technical difficulties in a remote environment. - Ability to work independently under general instructions and with a team - strong oral, written, and interpersonal communication skills, problem-solving skills, facilitation skills, - Ability to work independently under general instructions and with a team Preferred Qualifications - BSN degree - Experience with MCG/InterQual - Health Plan experience, Medicare/Medicaid experience Additional Information Workstyle: Remote work at Home Location: Must reside in a state participating in the enhanced nurse compact licensure, (eNLC) Schedule: Must work a minimum of 8 hours between 8:00AM to 5:00 PM Eastern Time, may be required to work rotating holidays or weekends as determined by business needs Travel: Less than 5% to attend onsite market meetings as business needs WAH Internet Statement To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. SSN Alert Statement Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from Humana@myworkday.com with instructions on how to add the information into your official application on Humana’s secure website. HireVue As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. About us About Humana: Humana Inc. (NYSE: HUM) is a leading U.S. healthcare company. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare and Medicaid, families, individuals, military service personnel, and communities at large. Learn more about what we offer at Humana.com and at CenterWell.com. ​ Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

Ready to help us transform healthcare? Bring your true colors to blue. This is a part time position with an expectation of working 4 hours per week. The Role This part time position is responsible for the clinical integrity, accuracy and consistency of our dental service reviews. The consultant evaluates documentation for clinical dental services submitted under various CDT codes to ensure they represent necessary and appropriate care for our members. These reviews can occur as pre-treatment estimates, claim submissions after the services have been completed or as appeals to initial denials. In performing these duties, the dental consultant will collaborate with cross-functional team members for consultation and advice, ensuring all reviews are conducted thoroughly and in accordance with our established guidelines. Collaboration is performed through various channels including but not limited to emails, phone calls, internal systems and meetings. Excellent communication skills are essential, as the consultant will also contact submitting providers as needed to clarify documentation or deliver determination notifications. Your Day to Day 1. A primary responsibility is to evaluate the clinical necessity, appropriateness, and efficacy of dental procedures requested or performed. This involves using a set of formal techniques to review the dental care request and collaboration with others for proper adjudication. The expectation would be the ability to daily review the limited clinical assignments so that adjudications can be made on a timely basis in accordance with regulatory standards. 2. Collaborate with various business areas to offer guidance and solicit input into clinical policies. This collaboration would be primarily with dental utilization reviewers from claim operations and dental network managers from our network contracting division. 3. Interact with dental providers when there is a question about the documentation submitted for claim predetermination or review to assure all necessary information is being considered before adjudication. 5. Represent Dental Blue at professional meetings and maintain active involvement with organized dentistry. This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties. We’re Looking for: Strong Clinical Foundation: A robust clinical background in dentistry is essential. This candidate would be a licensed dentist in Massachusetts, preferably with extensive experience in a clinical setting. This practical experience is vital for making credible assessments of the necessity and appropriateness of various dental treatments and procedures. Keen Analytical and Critical-Thinking Abilities: The position demands strong analytical skills to interpret and apply clinical guidelines to specific cases. A candidate must be proficient in evaluating dental records, treatment plans, and other clinical data to make objective, evidence-based decisions. Unyielding Ethical Standards: Given the nature of the role, which involves making determinations that impact patient care, a high degree of ethical integrity is necessary. The consultant must be capable of making judgments that are impartial and consistent with our policy of fair reviews. Exceptional Communication Skills: Effective communication skills are important for this role. The consultant will need to interact with dental providers to request additional information or to provide clarification on review decisions. The ability to engage in clear and professional dialogue is essential. Meticulous Attention to Detail: The review process is detail-oriented and requires a methodical approach. A candidate should be highly organized and thorough to ensure that all relevant information is considered and accurately documented and responded to in a timely manner. What You Bring: Education - Doctor of Dental Surgery (DDS) or Doctor of Dental Medicine (DMD): A foundational requirement for this position is a degree from an accredited dental school and a current unrestricted dental license in Massachusetts. This ensures the candidate has the necessary clinical knowledge to understand and evaluate a wide range of dental procedures and treatments. - State Licensure: The candidate must hold a current, unrestricted license to practice dentistry in Massachusetts. This is a standard requirement for any practicing dentist and demonstrates that they have met the state's requirements for professional practice. - Clinical Practice: Significant experience in a clinical setting as a practicing dentist is crucial particularly as a general dentist. This hands-on experience provides the practical knowledge needed to assess the appropriateness and necessity of care in real-world situations. A number of years of clinical practice would be expected. - Utilization Review or Insurance Experience: While not mandatory, prior experience in utilization review, quality assurance, or a similar role within the dental industry would be highly advantageous. This experience would indicate familiarity with the principles of managed care, clinical guidelines, the review process and comparable computer skills applications in Outlook, Word, and Excel. - Knowledge of Dental Coding and Terminology: A strong understanding of dental coding systems (such as CDT) and terminology is essential for accurately reviewing claims and treatment plans. In summary, the ideal candidate would be a licensed dentist with substantial clinical experience, and preferably, a background in the dental insurance industry with excellent communication skills. What You’ll Gain: Supplementation to Clinical Practice - Work-Life Balance: These positions typically offer a supplementation to your private practice schedule and the ability to use your clinical knowledge from practice in an administrative role to enhance the value of care to our members. - Reduced Physical Strain: An office/home based review role eliminates or reduces the physical stress often found in clinical dentistry. - The role provides an opportunity to affect dental care on a much larger scale than is possible when treating individual patients. - System-Level Influencing ensures that care is delivered to thousands of members in an efficient, effective, and necessary manner. - Focus on Evidence-Based Dentistry: The position is deeply rooted in the analytical application of the latest clinical guidelines and evidence, which can be educational about the science of dentistry. - New Skill Acquisition: It allows a clinician to develop valuable new skills in areas like data analysis, health policy, communication, and working within a corporate structure. In essence, this position appeals to experienced dentists who are looking for a new challenge, a better work-life balance, and a chance to apply their clinical knowledge to improve the healthcare system from a different vantage point. Minimum Education Requirements: High school degree or equivalent required unless otherwise noted above Location HinghamTime Type Part time Hourly Range: $120.32 - $147.06 The job posting range is the lowest to highest salary we in good faith believe we would pay for this role at the time of this posting. We may ultimately pay more or less than the posted range, and the range may be modified in the future. An employee’s pay position within the salary range will be based on several factors including, but limited to, relevant education, qualifications, certifications, experience, skills, performance, shift, travel requirements, sales or revenue-based metrics, and business or organizational needs and affordability. This job is also eligible for variable pay. We offer comprehensive package of benefits including paid time off, medical/dental/vision insurance, 401(k), and a suite of well-being benefits to eligible employees. Note: No amount of pay is considered to be wages or compensation until such amount is earned, vested, and determinable. The amount and availability of any bonus, commission, or any other form of compensation that are allocable to a particular employee remains in the Company's sole discretion unless and until paid and may be modified at the Company’s sole discretion, consistent with the law. WHY Blue Cross Blue Shield of MA? We understand that the confidence gap and imposter syndrome can prevent amazing candidates coming our way, so please don’t hesitate to apply. We’d love to hear from you. You might be just what we need for this role or possibly another one at Blue Cross Blue Shield of MA. The more voices we have represented and amplified in our business, the more we will all thrive, contribute, and be brilliant. We encourage you to bring us your true colors, , your perspectives, and your experiences. It’s in our differences that we will remain relentless in our pursuit to transform healthcare for ALL. As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. Learn how we are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path by visiting our Company Culture page. If this sounds like something you’d like to be a part of, we’d love to hear from you. You can also join our Talent Community to stay “in the know” on all things Blue. At Blue Cross Blue Shield of Massachusetts, we believe in wellness and that work/life balance is a key part of associate wellbeing. For more information on how we work and support that work/life balance visit our "How We Work" Page.

Business Analytics Advisor – Value-Based Care Analytics Do you love turning complex health data into insights that change how care is delivered? In this role, you will use advanced analytics to shape value-based care programs that improve affordability, quality, and outcomes. You will work with passionate experts across the organization to design solutions that help clinicians and partners make better decisions. We are an ambitious, collaborative team that values curiosity, compassion, and continuous learning. Responsibilities • Design and influence value-based payment programs by translating complex data into clear, actionable insights that support affordability and quality goals. • Lead advanced and exploratory analyses to uncover trends, root causes, and new opportunities within healthcare and specialty care data. • Apply strong statistical and analytic rigor to evaluate pilots and initiatives, supporting confident, data-driven decisions. • Build and maintain financial and analytic models that inform program design, forecasting, and performance reconciliation. • Partner closely with clinical, technical, and business teams to embed insights into tools and solutions used by providers and leaders. • Clearly communicate findings and recommendations to non-technical audiences to influence strategy and action. Qualifications Required • At least 5 years of experience in healthcare analytics, value-based care analytics, or related research roles. • Strong experience working with healthcare data such as medical claims, clinical, pharmacy, and eligibility data. • Advanced analytical skills using SQL and tools such as SAS, R, and/or Python. • Solid grounding in statistical methods including regression, confidence intervals, power analysis, and model validation. • Working knowledge of value-based care models such as ACOs, episodes, or bundled payments. • Ability to manage multiple priorities in a fast-paced, matrixed environment. • Clear and confident written and verbal communication skills. Preferred • Master’s degree or equivalent experience in statistics, data science, public health, health economics, or a related field. • Experience with medical economics or healthcare financial modeling. • Experience creating visualizations and storytelling through tools such as Tableau or Python-based libraries. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 107,700 - 179,500 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. About The Cigna Group Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.