Enthrive

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Premium Products 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 for 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 special focus on Medicare Advantage. Our client engagements include small to medium-sized companies. Each of our client engagements eventually move 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 improvements in quality and productivity for our customers.


Our first 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. This is achieved through recruitment, retention and training of top professionals and consultant software developers.

Products

Our Solutions for the Medicare/Medicaid Markteplace:

METS
Medicare Enrollment and Membership Management System for Health Plans and TPAs
HERO
Analytical Tools for Risk Adjustment and Revenue Recovery
Broker Portal
Portal to manage Medicare Broker Commissions, Certifications, Training and Compliance


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


   
        Premium         Billing
Premium Billing system for Medicare Advantage. Facilitates Group billing, split billing, lockbox matching, invoice generation, Capitation and LEP billing.
Appeals & Grievances
Full Appeals & Grievances solution based on CMS CADG guidelines

    Audit     Assistant
Repository for managing Audit Universes during CMS Audits

Section 111 MSP Reporting
Assists RREs in implementing the new Section 111 (MMSEA) MSP Reporting requirements
PDE   Management*
Helps MA-PD and PDP customers manage the PDE pre-edit, submission, error correction and reconciliation process

RAPS Management
Helps MA-PD customers manage the RAPS pre-edit, submission, error correction and reconciliation process

      * Exclusively sold through a valued partner

Services

Our Services for Medicare/Medicaid Health Insurance Plans

Consulting
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.
Training
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

Support

Product and Service Support

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



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

Contact Us

To contact our Sales/Support Staff:

Location

Address: 23535 Palomino Dr, Ste 250, Diamond Bar, CA 91765
Phone: 909-248-4591

Careers

We are looking for

Medicare Consultants
We are urgently seeking 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
We are urgently seeking 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.


Request for Demo


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