ICANotes

Billing and revenue-cycle workflows for a US behavioral healthcare EHR.

ICANotes is a behavioral healthcare EHR for US clinicians and large practices. I build clinical, billing and insurance workflows with TypeScript, Angular, NestJS, Node.js, MySQL and AWS.

My work includes the billing worklist, insurance coverage queries, patient payments and Electronic Remittance Advice (ERA) processing for payment reconciliation. I also investigate production behavior through Kibana and collaborate with US product and engineering teams on planning, architecture and code reviews.

Context

Challenge

Improve the performance and reliability of billing workflows in a large behavioral healthcare EHR without compromising complex insurance and reconciliation rules.

Execution

Engineering improvements

Reduced the unbilled encounters worklist p95 from 47s to 9s in k6 load testing by simplifying insurance coverage queries.
Traced production lock waits of up to 46.9s to repeated charge cancellation requests.
Blocked duplicate UI requests and skipped database writes for charges already marked as aborted.
Built ERA processing for insurance payments and reconciliation workflows.

Trade-offs

Architecture decisions

Used k6 results and production Kibana evidence to prioritize changes instead of relying on anecdotal performance reports.
Addressed duplicate operations at both the UI and persistence boundaries to reduce repeated work safely.
Kept billing capabilities within the existing Angular, NestJS, MySQL and AWS platform.

Measured and verified

Evidence

47s → 9s p95 in k6
Lock waits traced up to 46.9s
US healthcare SaaS

Delivered value

Outcome

Reduced p95 latency for the unbilled encounters worklist from 47s to 9s in k6 load testing and addressed the duplicate-request path behind production lock contention.

Development date: Sep 2023 ~ Present
Tags: Web, APIs
Main technologies: Angular, NestJS
Links: ICANotes Billing Features

Product views and engineering evidence

Project gallery

Billing worklist with encounter filters and revenue-cycle actions.
Insurance details used by clinical billing workflows.
Secure entry point for the ICANotes healthcare platform.

Interested in the way I approach product engineering?