Enterprise Legacy Modernization & Strategic Onboarding

As the technical lead for the Tennessee Department of Intellectual and Developmental Disabilities (TN DIDD) Phase 1 project, I was responsible for the high-stakes transition of active providers and service recipients from a legacy Electronic Health Record (EHR) system to the Therap platform. The state required a seamless onboarding process that integrated their massive service catalog—comprising over a thousand distinct services—while ensuring that every service configuration aligned with complex, specific funding source behaviors. The primary challenge involved maintaining the integrity of deep person-centered healthcare data and avoiding HIPAA violations during the migration of sensitive state government records.

I performed comprehensive Business Analysis and Project Management to bridge the gap between state business requirements and technical execution. To facilitate the migration, I collaborated with technical teams to design provider templates and utilized browser automation scripts for large-scale data imports, while simultaneously leading the development of a custom demographic API for secure data exchange. I managed the critical person-provider association process with a focus on Data Governance and Risk Management to prevent data breaches. Furthermore, I orchestrated the design of a customized Person-Centered Plan workflow that featured built-in authorization processes, ensuring technical feasibility through constant coordination with software engineering teams.

Through effective Cross-Functional Orchestration and rigorous User Acceptance Testing (UAT), I successfully delivered the Phase 1 infrastructure on schedule, enabling the secure transition of TN DIDD's vast provider and recipient network. The implementation of the demographic API and automated import processes ensured that critical health information was integrated without manual errors, supporting the state’s rigorous architectural standards. This project established a scalable foundation for the state’s healthcare operations, ensuring that the unified system could track complex funding loops and service delivery for thousands of individuals across the jurisdiction.

Projects & Accomplishments

Tennessee Department of Disability and Aging

Bridging the Compliance Gap: EVV Interoperability for TN DDA

During the initial phases of the Tennessee Department of Disability and Aging (TN DDA) implementation, it became clear that providers needed an immediate solution to satisfy Electronic Visit Verification (EVV) requirements before the platform's integrated billing module was live. I spearheaded the design of a sophisticated, intermediate interoperability framework to solve this challenge.

I architected a bidirectional data flow: first, building an SFTP-based unidirectional interface to ingest authorizations from the state’s legacy system; second, developing a scheduled outbound interface to transmit documented service data to the state vendor for claim validation. This project required balancing high-frequency reporting schedules with strict data formatting requirements. By acting as the technical architect for this "bridge" solution, I ensured that Tennessee providers could continue to document visits and receive payments without interruption during the larger system transition.

Strategic Revenue Cycle Management (RCM) & Interoperability

Building upon the Phase 1 modernization, I led the Phase 2 implementation for the Tennessee Department of Intellectual and Developmental Disabilities (TN DIDD), which focused on establishing a comprehensive, end-to-end Revenue Cycle Management (RCM) system. The state sought to transition from fragmented paper-based documentation to a fully integrated electronic billing ecosystem. This high-stakes initiative required managing a multi-year project lifecycle with a mandate to ensure the "state dollar life cycle" remained fully auditable. The challenge involved coordinating approximately six complex interfaces with external entities, including the MMIS, major Managed Care Organizations (MCOs) like BlueCross BlueShield and UnitedHealthcare, and various third-party vendors.

As the Technical Lead, I drove the Cross-Functional Orchestration and Business Analysis required to categorize over a thousand services into regulated documentation and claiming workflows. I architected funding sources and MCO association interfaces, ensuring that automated X12 837/835 claim transmissions were accurately routed based on complex payer logic. To maximize operational excellence, I established rigorous system-level claim edits to minimize payer rejections and reduce provider administrative overhead. I also designed a transition strategy for existing platform users to migrate to the new integrated state system without service disruption, while simultaneously developing automated, scheduled reporting frameworks to meet the state's accounting and oversight requirements.

The project successfully unified the entire service continuum—from demographic intake and person-centered planning to authorization and final payer response processing—into a single, transparent ecosystem. This integration provided the state with unprecedented oversight and audit capabilities over provider service delivery and financial data. By delivering a consistent, regulated way for providers to receive authorizations and automate their billing cycles, I facilitated a mission-critical infrastructure that sustained portfolio growth and ensured compliance across multiple jurisdictions.

Orchestrating Complex Fiscal Ecosystems – ICF and Third-Party Billing

In the complex landscape of the Tennessee Department of Disability and Aging (TN DDA), financial operations often extend beyond a single platform. A significant challenge arose when coordinating with a third-party Fiscal Intermediary responsible for managing Respite services. To bridge this gap, I designed a sophisticated API-based integration that allowed the intermediary to receive real-time authorizations, complete with funding source and MCO associations. This architecture enabled external service documentation to flow seamlessly back into our platform, where the final billing steps were executed. By acting as the primary Business Analyst, I ensured that the data remained consistent across multiple entities, protecting the integrity of the state’s fiscal oversight.

The project expanded in complexity with the implementation of Intermediate Care Facility (ICF) billing. ICF services operate under a documentation model that is fundamentally different from standard community-based services. I led the technical customization effort to re-engineer the system’s documentation logic, specifically tailored to handle the unique processing requirements of ICF service delivery. Simultaneously, I addressed a widespread need for providers who utilized third-party documentation vendors. Rather than forcing these providers to abandon their existing systems, I engineered a "vendor-agnostic" solution. By repurposing the API framework I developed for the Fiscal Intermediary, I allowed these external vendors to transmit data into our billing engine, ensuring that day-to-day business remained unhampered while achieving total compliance with state billing standards.

A critical component of this success was the specialized attention given to RHA Health Services, a unique provider whose enterprise-scale operations required a bespoke system design. I navigated the delicate balance of preserving RHA’s established business processes while ensuring they met the rigorous TN DDA billing mandates. Throughout the Billing Implementation, I managed comprehensive UAT and Risk Management protocols, validating every interface and data mapping. The result was a unified, high-performance fiscal ecosystem that empowered the state, third-party partners, and large-scale providers to operate with 100% financial transparency and zero payment interruptions.

Sustainable Governance – Standardizing Transitions and Fiscal Migrations

Following the initial go-live for the Tennessee Department of Disability and Aging (TN DDA), the focus shifted from implementation to long-term sustainability. The state faced a complex environment where providers were frequently transitioning their service delivery documentation methods—some moving onto our platform while others opted for third-party vendors. I spearheaded the design of a standardized Vendor Transition Process that prioritized provider autonomy. By creating a repeatable technical roadmap for these migrations, I successfully reduced the need for direct technical team involvement, allowing for a smooth, self-sustaining transition ecosystem that protected the integrity of documented data.

As the state’s provider network grew, I identified a need for more efficient Billing Management. I established a rigorous onboarding process for new providers and service types that functioned with minimal technical supervision. This involved creating a "template-driven" configuration model that allowed business teams to manage service changes and site additions independently. This shift not only accelerated the onboarding timeline for new providers but also ensured that the system remained agile enough to handle the frequent service modifications inherent in large-scale state contracts.

The cornerstone of the project’s long-term stability was the development of a Unified Rate Migration Framework. Tennessee's fiscal year rate changes for both community-based and Intermediate Care Facility (ICF) services often presented a high risk for billing interruptions. I worked directly with state leadership to re-engineer the business process for rate ingestion. By establishing a synchronized update cycle, we ensured that the system automatically applied new rates to authorizations for the upcoming fiscal year. This proactive approach to Reporting Management and Risk Management has resulted in zero-interruption fiscal transitions, providing TN DDA with a reliable, future-proof billing infrastructure.