A Comprehensive Suite of Solutions to Help Organizations Achieve Measurable Results
We leverage process intelligence, resource alignment, and strategic communication to streamline operations and drive outcomes across healthcare and technology sectors.
Healthcare System Services
We support healthcare administration for TPA, MSO, IPA, ACO, PACE, DCE, and payers with deep domain expertise and hands-on implementation experience. Our team delivers precision across every layer of healthcare operations.
- System Configurations: EZ-CAP, Plexis/QC, QuickCap/Medvision
- Eligibility Processing & Management
- Provider Management: Creation, Updates, Contracts & Fee Schedules
- Delegation of Financial Responsibilities
- Configuration of Benefits
- Claims Processing Automation & Management
- Adjudication & Claims Pricing/Re-pricing
- UM Process Improvement & Automation
- Capitation Management & Reporting/Analytics
Electronic Data Interchange (EDI)
Seamless data exchange and system integration across all major HIPAA transaction sets. We map, analyze, and integrate your systems to ensure accurate, timely, and compliant data flows between all stakeholders.
- OCR: Document/Image Capture & Transformation
- Mapping & Gap Analysis
- Integration with Provider PMS / Clearinghouse / TPA
- HIPAA Transactions: 837, 835, 278, 276/277
- Payor Transactions: TA1, FA, 276/277
- Benefit Enrollment & Maintenance (834)
- Eligibility Inquiry/Response (270/271)
- Sponsor/Clearinghouse/TPA Acknowledgements
Operational Assessments & Process Improvement
We conduct comprehensive operational reviews to identify gaps, optimize workflows, and re-engineer business processes for efficiency and compliance. Fully committed to HIPAA standards including Privacy, Security, and Electronic Transactions.
- Complete Operational Assessments
- Business Process Re-engineering
- Strategic Resource Planning
- End-to-End Process Review / Process Intelligence
- Process Improvement using Intelligent Automation
- HIPAA Compliance Review & Remediation
Implementation Support
From system selection through go-live and beyond, our experienced project teams ensure successful delivery with minimal risk and maximum adoption. We bring best-practice frameworks, proactive risk management, and disciplined execution.
- Project & Resource Management
- System Selection & Legacy System Support
- Risk Mitigation & Best-Practice Guidance
- Integration & Testing
- Pre/Post Go-Live Support & Optimization
- Data Migration & Utilities/Interfaces Development
Software Development & Testing
From custom applications to QA automation, our engineering teams deliver reliable, scalable software solutions. We cover the full development lifecycle and specialize in independent validation for mission-critical healthcare systems.
- Custom Application Development & Maintenance
- Decision Support & Application Services
- System Planning & Implementation
- Data Conversion, Migration & Integration
- Benefits Realization & Decision Support Applications
- Process Automation & Complex Reports Development
Software Testing
- Independent Black Box Testing
- Reverse Engineering
- QA Automation
Data Platforms & Analytics
End-to-end consulting and implementation for data platforms tailored to your business objectives. We transform raw data into actionable intelligence that drives smarter decisions and measurable outcomes across your organization.
- Requirement Analysis & Architecture Design
- Data Platform Design & Development
- Testing & Deployment
- Reporting & Advanced Analytics Solutions
- Integration with Existing Data Sources
- Ongoing Optimization & Support
Workflow Optimization & Intelligent Automation
We streamline your most complex processes through intelligent automation, reducing manual effort, minimizing errors, and dramatically improving throughput and operational efficiency across all departments.
- Process Mapping & Automation Opportunity Analysis
- RPA & Intelligent Automation Implementation
- Claims Processing Automation
- UM Process Improvement & Automation
- Auto Adjudication Optimization
- Performance Monitoring & Continuous Improvement
Communications Mentorship
A unique and essential differentiator — Optivera provides structured guidance and training to client teams on strategic communication, stakeholder engagement, and collaborative workflows. We ensure knowledge transfer and sustainable operational success long after project completion.
- Strategic Communication Framework Development
- Stakeholder Engagement Training
- Collaborative Workflow Design
- Knowledge Transfer Programs
- Executive & Team Mentorship Sessions
- Long-Term Alignment & Sustainability Planning