Hybrid deterministic + LLM analysis for healthcare claim denials (EDI 837/835). Grounded LLM citations, calibrated confidence, batch denial clustering, full eval harness. Live demo on Streamlit Cloud.

X12 EDI Claims Pipeline — 270/271 eligibility, 837P professional claims, 835 remittance advice with revenue cycle analytics. Built with Synthea FHIR R4 synthetic data.

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.

PostgreSQL 15 ETL pipeline simulating 837/834/835 EDI ingestion with a 12-rule automated data quality engine, exception logging, and financial reconciliation across 2 claim batches.

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.

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.