15+ years building the EDI and revenue-cycle systems behind U.S. healthcare payments. I helped carry a clearinghouse from early stage to tens of millions of transactions a day, through two acquisitions, then led its integration into a national RCM platform with zero-downtime migrations along the way.
I work on the hard parts of healthcare EDI, from the eligibility check to the remittance. On my own time, I write about what I'm building and learning; the current series is Teaching AI to Read Payer Edits.
I write up what I'm building and learning as I go, including the parts that didn't work.
Payer-specific rules (SNIP levels 6 and 7) are scattered across hundreds of companion guides and bulletins, and most get discovered one rejection at a time. This series follows the pipeline I built to read the guides and turn them into rules a human reviews before any claim is sent.
Led the multi-year integration of a clearinghouse platform into Waystar's core RCM platform, moving professional and institutional claim clients while dental remained on the legacy platform. The work included multiple zero-downtime migrations under full production load, followed by a transfer of ownership to a newly formed team.
Re-architected the claims processing pipeline for horizontal scale as transaction volume grew, and rebuilt internal clearinghouse applications for fault tolerance and observability, with activity logging and monitoring across the platform.
Led the enterprise migrations from X12 4010 to 5010 and from ICD-9 to ICD-10, both against federal compliance deadlines, while claims kept flowing through the platform.
Built national-scale 270/271 eligibility and 276/277 claim status services, answering in real time instead of in batch, so coverage and claim progress can be checked while the provider is working rather than the next day.
Led a multi-year clearinghouse integration into Waystar's RCM platform and was responsible for the claims infrastructure end to end. Contributed to Waystar Recoupment Manager, a launched AI product that matches payer PLB adjustments against paid claims to surface post-payment recoupments.
Principal technical owner of the clearinghouse platform. Managed a cross-functional team of six across healthcare EDI and RCM applications.
Directed development of the clearinghouse platform through its highest-growth years. Increased 837 file throughput tenfold and built a hybrid role- and attribute-based access system used across all internal applications.
For eight years, the same small group of engineers has met every few weeks to test each book's advice against the code we actually maintain. Domain-Driven Design gave me the vocabulary for bounded contexts. Generative AI with LangChain started the payer-edit project.
Reading now Generative AI Design Patterns · Lakshmanan, Hapke