Claims shouldn't learn payer rules by getting rejected.
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 Durable Workflows for Healthcare Data.
I write up what I'm building as I go, including the parts that didn't work. I also research trends in healthcare EDI and write about what I learn.
Currently writing
Durable Workflows for Healthcare Data
The claim lifecycle is a conversation that runs for weeks. This series looks at where durable workflows fit in it and where they don't, based on what I learned trying them in a personal sandbox.
Systems that carry real claims, at scale, without stopping.
Waystar · 2020–present
Platform integration and handoff
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.
ResultNo interruption to customer claim submission. A team of four went from no X12 experience to running the platform independently.
eSolutions · 2016–2020
Claims processing built for scale
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.
ResultClaims turnaround cut from hours to minutes.
ClaimRemedi · 2010–2016
Industry mandates that couldn't pause claims
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.
ResultDeadlines met with uninterrupted claims processing throughout.
ClaimRemedi · 2010–2016
Real-time eligibility and claim status
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.
ResultReal-time responses at millions of requests a day, CAQH CORE certified.
Experience
Fifteen years in healthcare claims.
2020 – now
Waystar
Software Architect · Staff Software Engineer
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.
2016 – 2020
eSolutions
Manager of Application Engineering · Senior Application Engineer
Principal technical owner of the clearinghouse platform. Managed a cross-functional team of six across healthcare EDI and RCM applications.
2010 – 2016
ClaimRemedi
Lead Clearinghouse Engineer · Software Engineer
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
Architecture and design
Domain-Driven Design · Evans
Designing Data-Intensive Applications · Kleppmann
Fundamentals of Software Architecture · Richards, Ford
Building Evolutionary Architectures · Ford et al.
Clean Architecture · Martin
A Philosophy of Software Design · Ousterhout
Designing Distributed Systems · Burns
Principles of Web API Design · Higginbotham
System Design Interview · Xu, Lam
Microservices and events
Building Microservices · Newman
Monolith to Microservices · Newman
Practical Microservices · Garofolo
Building Event-Driven Microservices · Bellemare
Operations
Kubernetes: Up and Running · Burns et al.
Observability Engineering · Majors et al.
Operating Continuously · Rinaldi et al.
Craft
Clean Code · Martin
Refactoring · Fowler
Test Driven Development · Beck
Adaptive Code · McLean Hall
Head First Design Patterns · Freeman, Robson
A Common-Sense Guide to Data Structures and Algorithms · Wengrow
CLR via C# · Richter
Practical Guidelines and Best Practices · Balena, Dimauro
AI and LLMs
Generative AI with LangChain · Auffarth, Kuligin
Hands-On Large Language Models · Alammar, Grootendorst
Fundamentals of Artificial Intelligence
Career
The Staff Engineer's Path · Reilly
Build sessions
fast.ai practical deep learning · 2018
Local image generation with FLUX and ComfyUI · 2025
