Work · Medicaid managed care

The first enterprise data platform a Medicaid managed-care organization ran outside its core warehouse.

Architecture and a 12-person team for a Medicaid managed-care organization in North Carolina: automated financial reporting and remittance-advice verification, AI-assisted documentation of undocumented stored procedures, and the pattern for EDI claims modernization.

Client
A Medicaid managed-care organization
Where
North Carolina
When
May 2024 – Nov 2025
Role
Development Lead and Enterprise Solution Architect, IBM Consulting

The problem

Everything the organization knew about its claims lived inside the core MMIS enterprise data warehouse, on that system's schedule and in that system's shape. Financial reporting and the verification of vendor remittance advice were largely manual, which meant slow month-end closes and defects that only surfaced when the numbers did not reconcile.

Underneath sat stored procedures of ten to twenty thousand lines with no documentation and no one left who had written them. Every change was a risk, and every new engineer took months to become useful.

The decision

I solutioned the organization's first enterprise data platform outside the MMIS warehouse: its own data governance, pipeline orchestration, and analytics capabilities, built so it could grow without waiting on the core system. Then I led architecture and development strategy for a 12-person team that automated the financial reporting and the remittance-advice verification on top of it.

For the undocumented code, I brought AI-assisted documentation into the SDLC: large language models produced first-draft documentation of the stored procedures, engineers verified and corrected it, and the result became part of the definition of done rather than a one-time cleanup.

In parallel I drove the partner-level architecture for modernizing EDI claims and encounters processing: the integration patterns, the data standards, and a platform design that scales beyond one line of business.

What changed

  • Month-to-month verification of vendor remittance advice improved 50%, and the automation surfaced critical system and configuration defects that manual checks had missed.
  • Documented stored procedures cut knowledge-transfer time and reduced defects introduced by changes to code nobody understood.
  • The organization has a data platform it owns and a documented pattern for EDI claims and encounters modernization.

Stack

  • SQL Server
  • Pipeline orchestration
  • Financial reporting automation
  • EDI 837 / 835
  • LLM-assisted documentation
  • Azure DevOps