Enthrive

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.

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 Mgmt
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: 774-423-7666

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


Blog

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.

View memo
Read our expert opinion
By Jeff Hewitt
  • 2 days, 8 hours
  • |
  • 2 comments
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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) . . . .

View memo
Read our expert opinion
By Jeff Hewitt
  • 71 days, 3 hours
  • |
  • 2 comments
  • |
  • |

Careers

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: