HEDIS Gaps-in-Care Automation

A leading healthcare client approached Pyx with a strategic opportunity—worth over $1M—to help close "Gaps in Care" for Medicaid and Medicare members by increasing the completion of essential health screenings (e.g., cancer screenings, postpartum care, wellness visits). This work was outside Pyx's typical service model, but opened a new business vertical if executed successfully. The client expected weekly ingestion of large member files, outreach and scheduling of visits, and compliant reporting back to state health entities.

I led the initiative end-to-end—from opportunity assessment to prototyping and delivery—without pulling Dev team resources from other critical priorities. I handled stakeholder engagement, system design, automation, reporting, and compliance alignment. I took a no-code/low-code path to fast-track delivery while ensuring extensibility and reliability.

• Strategic Scoping:
  • Scoped a POC to test the opportunity and keep core tech resources unblocked
  • Held discovery sessions with Sales, Client Management, and the Customer Support team to map operational requirements and success metrics
• Process Automation:
  • Translated complex manual workflows into automated, scalable solutions using internal Microsoft ecosystem tools
  • Designed system architecture following Domain Driven Design principles for maintainability
• Performance Management:
  • Instituted weekly checkpoints and metrics tracking using dashboards and auto-generated reports to ensure transparency and drive outcomes