Prior Auth & Coverage
Humana and athenahealth take ePA nationwide
FHIR-based prior auth now covers athenahealth's 180,000+ clinicians. In September, over 70% of Humana requests needed no extra input from practice staff.
Read the full story →Ensemble launches predictive financial assistance in all 50 states
Sierra-powered voice agents and human advisers help patients keep Medicaid ahead of six-monthly renewals from January. Ensemble says it's helping nearly 50,000 patients a month find coverage options.
Read the full story →Funding & M&A
VisiQuate buys Artiva HCx from Finvi
The Accel-KKR-backed analytics firm now owns the work queues many hospital billing teams run on, and plans governed AI agents on top. Terms weren't disclosed.
Read the full story →Rivio raises a R$180M Series A extension
Valor Capital Group led the extension for the year-old São Paulo company, which gets paid on outcomes and counts Einstein and Sírio-Libanês as customers. Valuation: about US$200M.
Read the full story →Leadership Moves
FinThrive names Sam Meckey CEO
The former President of Optum Global Solutions takes over from retiring CEO Hemant Goel at the Clearlake-backed RCM platform.
Read the full story →Talent Insight
Execution needs operators
- Interoperability is a hiring market again. People who have put Da Vinci FHIR standards (CRD, DTR, PAS) into production are scarce, and every large plan needs them before January.
- Outcome-based RCM means running the work, not just licensing software. Billing operations leaders who can supervise AI agents are moving up the shortlist.
- After an acquisition: After an acquisition the first year is about keeping customers. Account management and integration leads matter as much as new-logo sellers.
Building a team in Digital Health & Healthcare AI?
Issy Eaden specialises in Digital Health & Healthcare AI hiring at QP Group. Talk to Issy about the market, salaries or a search.
