Domain

Insurance verification is one of the most time-consuming operational tasks inside healthcare practices. Staff manually log into payer portals, call insurance companies, or send faxes to confirm patient coverage.

Manual verification takes 10–15 minutes per patient and creates operational bottlenecks that directly impact patient experience.

At scale, this friction compounds across thousands of practices.

Overview

I led the 0→1 build of NexHealth Verification, a fully integrated insurance eligibility system designed to automate manual verification workflows across NexHealth’s provider base.

We built the system from the ground up in four months.

The product required:

Implementing real-time 270/271 EDI infrastructure
Designing a normalized benefits model that translated raw payer responses into actionable staff-friendly breakdowns
Building procedure-level benefit parsing for many payers
Creating automated retry and failure handling logic
Syncing eligibility results directly into provider EHR workflows
Generating daily verification reports and PDFs for operational visibility