BELFAST, Maine — Every day, trucks carrying a ton of mail — literally — arrive at medical billing company athenahealth’s Maine operations center. There, the 2,000 pounds of paperwork will be sorted and managed for the nearly 28,000 doctors and medical groups that make up the company’s clientele.

Workers in Belfast open the mail, electronically deposit checks and make sure that the many i’s are dotted and t’s are crossed for claims to be correctly processed the first time with insurance companies.

Additionally, employees sitting in the cubicles originally built as part of a major credit card call center solve problems for their clients, describing the work as different and challenging every day.

It’s a big task, but David Tassoni, senior vice president of operations at the Massachusetts-based company, says the Maine work force is up to it.

Since buying part of the former offices built by credit card giant MBNA three and a half years ago, athenahealth in Belfast has gone from having one employee to 350 and has expanded its midcoast footprint with the recent purchase of the Point Lookout resort in Northport.

“The real key to it has been the work force,” Tassoni said. “We have not needed to recruit. People enjoy this. They really enjoy what they do.”

Managing the mountains of mail, though a major endeavor, is only part of what the company does.

When founders Jonathan Bush and Todd Park started athenahealth in 1997, the two recent Harvard Business School graduates originally had wanted to make the San Diego women’s health clinic they had just purchased profitable. But they were stymied by the vast amounts of paperwork and complexities of submitting claims to insurance companies.

“They had this beautiful vision of how to run it, and they just started losing money. They had no control over how they got paid,” Tassoni said.

In order to better manage the medical practice, they had a friend build a “very light” version of athenaNet, the company’s Web-based system that makes the often-painful task of dealing with insurance companies easier.

The system was a success, and soon the two men got out of the direct-care business and into the business of managing medical practices.

The health care information technology company has grown significantly over the last 15 years, and now employs about 3,000 people in locations in Watertown, Mass., Belfast, Georgia and India.

“What happens in a small medical practice is that there are all these documents coming in. Faxes pile up. Someone has to go through those,” Tassoni said.

But when clients join athenahealth, they become subscribers to the now-sophisticated athenaNet, the company’s “cloud,” or Web-based, software program. Paperwork is sent to athenahealth instead of the office. Program updates happen simultaneously every six weeks. Security is paramount.

“Your information is secure in the cloud,” Tassoni said. “It has security all built around it and is backed up every five minutes. It’s just a better system.”

He said the company’s ultimate goal is to get it right the first time and to have a claim correctly processed the first time that it’s submitted to an insurance company.

“All the really just tough stuff that [medical practices] weren’t very good at, that nobody likes to do, the grunt stuff — that’s what we do,” Tassoni said.

A national priority

Those priorities are also shared by the federal government, which has been pushing to require national standards for electronic health care transactions and to encourage electronic data interchange in the American health care system since the Health Insurance Portability and Accountability Act was passed in 1996.

The Recovery Act of 2009 also included $19.2 billion to fund health information technology by developing more standards around the uses of electronic health data and by providing fiscal incentives for doctors, hospitals and other providers to use electronic health records, according to the Kaiser Commission on Medicaid Facts.

That means that companies such as athenahealth, which work to make those health records electronic, are well-placed for future growth, according to one Maine economist.

Shares in athenahealth (ATHN) have been publicly traded on the NASDAQ since 2007. After the market’s close on Friday, stock in the company was listed at $56.57 per share. According to Dow Jones & Co.’s Marketwatch website, that came close to the 52-week high of $60.29. The low during the same period was $25.18.

Charlie Colgan of the Muskie School of Public Service at the University of Southern Maine, said last week that athenahealth’s clientele and work is likely to expand significantly over the next decade. The U.S. lags behind the rest of the world in creating a system for electronic health records, he said, and there’s a major push to bridge that gap — both from federal and other sources.

“It’s A) a national priority, and B) attracting both private and public capital,” Colgan said. “The health care system is going to have to do more and more of what athenahealth does.”

David Cust, a financial adviser at Means Investment Company in Bangor, described the company as a solid player in the health care sector.

“The health care industry has benefited greatly from improved operational efficiencies and that is athenahealth’s core business,” he wrote Wednesday in an email sent to the BDN.

The growth potential in that field is enormous, with health care spending expected to double to $4 trillion by 2015, according to the Centers for Medicare and Medicaid Services.

But there are also risks.

“The technology sector is incredibly competitive,” Cust wrote. “Companies like Apple and Google may see opportunities in the health care sector and if so, with their deep pockets, could jump in full-force.”

He said more competition and the possibility of industry legislation and regulation are the two biggest challenges facing health care information technology companies.

“Athenahealth is a relative newcomer and it takes time to build name recognition and develop these footholds,” he wrote. “If they can develop new, innovative products, they can certainly increase their market share.”

Jumping through hoops

Farmington physician Joe Caldwell of Three Rivers Orthopedics said he used to spend about 30 hours a week — all his weekends — doing paperwork and completing medical records for his patients. But since he has signed up to have athenahealth manage his practice, that time has plummeted to less than eight hours a week.

Caldwell said he uses voice recognition with a headset and his computer transcribes what he says right into the company’s cloud-based system.

“Every week of my life, 52 weeks a year, I’m saving that much time now,” he said Wednesday. “It allows you to spend more time with your patients, diagnosing and treating.”

And that’s not the only benefit he associates with athenahealth.

Caldwell described the switch to electronic medical records as something that has been imposed on the medical community by third-party payers like insurance companies and the federal government, which oversees Medicaid and Medicare. He thinks the government’s promised financial incentives don’t begin to cover the costs and headaches of making the change.

“The hoops you have to jump through are absolutely phenomenal,” he said.

However, there’s a big upside, too. Electronic medical records allow doctors to streamline their work and make their medical record management “much more contained.”

Most of his practice’s mail is sent directly to athenahealth, which Caldwell called “liberating.” The company does its billings, collections and more. In part because the company works hard to make sure that claims are filed correctly the first time, Caldwell said that payments come in faster, more easily and are even larger than before. The money coming in is also deposited electronically to a bank and accounting has been simpler, too.

Because he’s so satisfied with what athenahealth has done for the practice, he has already recommended it to other colleagues.

“Being a doctor today is not just being a doctor,” Caldwell said. “It’s complicated. You have to put your running shoes on. You have to be able to go high tech. But it’s worth it when you get there.”

‘A great asset for Belfast’

Belfast wasn’t the only place, and Maine wasn’t the only state, that company officials looked at when it came time to expand, according to Matt Jacobson, president and CEO of the private economic development firm Maine & Company.

His group courted athenahealth for three years before they chose Belfast, he said Wednesday, adding that the company’s multimillion dollar purchase of Point Lookout is “great” for Maine.

“I think it’s terrific each time a company makes another investment in our state and digs their roots a little deeper,” he said. “I think for them to make more of a home here in Maine, they’re less likely to leave. I wish all of our businesses would make that kind of investment.”

Colgan described the selection of Belfast as a major operational site as “very interesting,” especially because the area is not known for having a medical-based work force or economy.

However, when athenahealth purchased part of the former MBNA building, it also built on the legacy of that company’s work force and infrastructure, according to the economist.

“I think it’s a really good example of how a relatively rural area can serve the modern high-tech service industry,” Colgan said. “I think the athenahealth story is very positive. Locating in Belfast shows that relatively simple call centers can shift up to high-tech service businesses.”

Local officials are cheered by the company’s purchase of Point Lookout, too. Although Tassoni said the resort will remain open to the public, as the originally private corporate retreat has been since 2008, the move seems like another sign that athenahealth is in Maine for the long haul.

“Any time you have an entity that hires full-time employees in your area purchasing an additional amenity, that’s good news,” said Belfast City Manager Joe Slocum. “It means long-term commitment, and boy, do we like to hear about long-term commitment.”

Tassoni said the company intends to remain in Belfast for the long-term, although the plan is to top out employment at 700 people. He said the firm has been adding about 100 employees a year since opening here.

“Athenahealth has just been a great asset for Belfast,” Slocum said. “They have steadily grown and hired employees. They’ve hired regularly and consistently, and those employees work here and spend their dollars here and live their lives here. We’re excited about that. We’re proud they chose Belfast. We’re proud they stayed, and we’re going to do everything we can do in the future to keep them here.”