Loading Studio
Architected and built the frontend portal for a B2B healthcare SaaS platform automating Independent Dispute Resolution (IDR) under the Federal No Surprises Act, allowing billing companies to extract out-of-network claims from Athenahealth and track arbitration submissions.
Under the No Surprises Act, out-of-network healthcare providers can dispute underpayments by insurance companies through the CMS federal IDR portal. However, billing companies manually spent hundreds of hours pulling claims records, downloading Explanation of Benefits (EOB) PDFs, verifying eligibility dates, and tracking multi-phase dispute statuses.
My task was to design the batch dispute workspace (BatchesDetail), engineer the Athena CPT-code claim extraction filters, implement a concurrent batch-downloader for PDF EOB files, and build the state tracking machine for Payor and CMS submissions.
Developed the claim extraction module (ClaimExtraction.tsx) supporting both automatic schedules and manual cron triggers using RTK Query. Programmed a browser-based batch EOB downloader that automatically parses patient files, filters for PDF formats, and triggers asynchronous parallel downloads. Built the core dispute detail workspace (BatchesDetail.tsx) tracking payor data, CPT codes, total disputed amounts, and federal deadline calendars. Integrated compliance modals (SubmitToPayor, Reopen, and Confirmation) linked to audit logs tracking user activity for administrative transparency.
Reduced administrative overhead for dispute resolution by over 60% through automated claim extractions and batch EOB file downloads. The platform successfully managed and processed millions of dollars in out-of-network claims, maintaining a 100% auditable record of payor and CMS dispute submissions.