Healthcare Consulting | Software Solutions | IT Services

Premium Solutions for the Medicare/Medicaid Marketplace

Company Profile

We are a healthcare consulting and IT services provider that specializes in solutions for the Medicare/Medicare marketplace. We offer subject matter expertise and consulting services to health plans in the Medicare arena and provide affordable business and technology solutions.Our company has a highly experienced management team, and employees offer you solutions that are tailored to your business needs.

We provide solutions to help companies enhance their current healthcare enterprise operations and ensure exceptional returns on investment. Our service offerings are varied, covering many aspects of the healthcare industry with a focus on Medicare Advantage. Our client engagement includes small to medium-sized companies. Each of our client engagements eventually moves to a level where we deliver scalable solutions that not only simplify business processes but improve operational efficiency, moving a step beyond straight cost savings. We are focused on learning and continuously improving our capabilities to drive changes in quality and productivity for our customers.

Our primary focus is always quality and process because we know this is where real gains can be achieved. Technical solutions alone do not bring long-term improvement. Quality is a top priority for us, and we take pride in our solutions. Our solutions are built to fit in with your processes or processes re-engineered to suit a better way of working. Either way, the process, and the solution must work together. We achieve quality delivery through a systematic recruitment process, employee retention strategies, and training of top professionals and consultant software developers.


Our Solutions for the Medicare/Medicaid Markteplace:

Medicare Enrollment and Membership Management System for Health Plans and TPAs
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Analytical Tools for Medicare Advantage Risk Adjustment and Revenue Recovery
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Broker Mgmt
Portal to manage Medicare Broker Commissions, Certifications, Training and Compliance
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COB     Management
State-of-art System that assists Health Plans with revenue recovery for Medicare Secondary Payer (MSP) and Coordination of Benefits (COB)
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Medicare Reconciliation*
Membership and Financial Reconciliation for Managed Medicare
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Medicaid Reconciliation*
Membership and Financial Reconciliation for Managed Medicaid
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        Premium         Billing
Premium Billing system for Medicare Advantage. Facilitates Group billing, split billing, lockbox matching, invoice generation, Capitation and LEP billing.
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Appeals & Grievances
Full Appeals & Grievances solution based on CMS ODAG/CDAG guidelines

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    Audit     Assistant
Repository for managing Audit Universes during CMS Audits

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Section 111 MSP Reporting
Assists RREs in implementing the Section 111 (MMSEA) MSP Reporting requirements
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PDE   Management*
Helps MAPD customers manage PDE pre-edit, submission, error correction and reconciliation process
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RAPS Management
Helps MAPD customers manage RAPS pre-edit, submission, error correction and reconciliation process
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      * Exclusively sold through a valued partner


Our Services for Medicare/Medicaid Health Insurance Plans

Our consultants have in-depth knowledge of Medicare/Medicaid and can provide expert advice and assistance to business users and IT departments on how to deal with day-to-day business challenges.
Analytical Tools for Risk Adjustment and Revenue Recovery

Application Services
State-of-art System that assist Health Plans with revenue recovery for Medicare Secondary Payer (MSP) and Coordination of Benefits (COB)
IT Services
Membership and Financial Reconciliation for Managed Medicare


Product and Service Support

Area for FAQ, Knowledgebase and forums
Product Support
Get support for specific products

Articles and Publications
View Articles and publications
Links to Consumer and CMS websites

Contact Us

To contact our Sales/Support Staff:


Address: 23535 Palomino Dr, Ste 250, Diamond Bar, CA 91765
Phone: 774-423-7666

Schedule a Demo:     To Request a Demo, Please send an email to Sales@enthrive.com


Some musings from us . . .

CMS Announcement 2019

CMS just released Announcement of Calendar Year (CY) 2019 Medicare Advantage Capitation Rates and Medicare Advantage and Part D Payment Policies and Final Call Letter.

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Read our expert opinion
By Jeff Hewitt
  • 2 days, 8 hours
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Enrollment Guidance Policy Changes and Updates for Contract Year 2019

The Centers for Medicare & Medicaid Services (CMS) published regulation changes that impact enrollment in CMS-4182-F (Contract Year 2019 Policy and Technical Changes to the Medicare Advantage, Medicare Cost Plan, Medicare Fee-for-Service, the Medicare Prescription Drug Benefit Programs, and the PACE Program) . . . .

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Read our expert opinion
By Jeff Hewitt
  • 71 days, 3 hours
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We are looking for

Medicare Consultants
We have immediate opportunities for consultants to join our fast-growing practice. These positions call for individuals who can provide leadership, facilitation, support, strategic direction, oversight, and project management for multiple customer engagements in the areas of Medicare reconciliation, Medicare reimbursement, Medicare Part C and Part Compliance, Medicare Risk Adjustment and Medicare Enrollment processes.

The ideal candidate will have:
Bachelors degree and/or equivalent experience required. Masters degree preferred. 5+ years of experience in one of the Medicare disciplines described above. Demonstrated ability to develop manage and grow customer relationships. Knowledge of health plan and Medicare business processes, including Risk Adjustment, Part C and Part D, membership management, revenue reimbursement and other related areas. Excellent problem-solving, interpersonal, verbal and written communication skills. Experience in data analysis, process management and systems design. Experience in process redesign and change management methodologies. Subject matter knowledge in finance, health plan operations, claims, clinical coding or systems would be a plus.
Sr. VB/C#.Net and Database Programmer
Candidates must have a BE/MS in Computer degree and 3 or more years of .Net experience. Preference will be given to candidates with prior healthcare-related training experience, but will also consider candidates with experience in other industries. Must be able to work in a fast-paced environment, manage a team, as well as possess the ability to learn about new technologies and a variety of software products. This role requires customer interaction, managing customer relationships, analyzing current customer business processes & requirements and making recommendations for process improvement. Light travel required.

The ideal candidate will have:
.NET Development (min 3 years), C#, VB.Net (min 3 years), WinForm Development (min 2 years), Object Oriented Analysis and Design (min 4 years), ADO.NET (min 3 years), T-SQL, Stored Procedures and Triggers (min 4 years), SQL Server 2000, or Oracle (min 4 years), Excellent communication skills

Request for Demo

Our Sales Team will be in touch with you to schedule a personalized demo: