Multi-factor denial risk scoring and queue assignment engine for healthcare RCM operations. Routes 1,200+ claims across 5 operational queues using a 7-factor weighted model.
Pre-submission EDI 837 validation pipeline enforcing payer-specific rules across BCBS, Aetna, Cigna, and Humana. Identifies $430K+ revenue at risk across 1,200+ claims per run.
Python ETL pipeline that moves clinical data between FHIR servers, uses SNOMED CT/Hermes for terminology mapping, and generates HL7 v2 ADT messages
Two-tier Python matching engine parsing raw 837/835 EDI files, auto-classifying payments into 6 categories and surfacing $430K+ revenue at risk across 1,200+ claims.
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