Conf42 Prompt Engineering 2025 - Online

- premiere 5PM GMT

Prompt Engineering Healthcare Compliance: Automating 102 Benefits for 2M+ Members

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Abstract

When CMS mandated Medicare Advantage supplemental benefit reporting in 2024, we faced an unprecedented data challenge: consolidating 102 benefit types from more than ten disparate systems for two million members. This presentation reveals how prompt engineering and AI-assisted development accelerated our solution delivery.

Our approach leveraged prompt engineering across the entire development lifecycle. We used large language models (LLMs) to rapidly prototype ETL logic for complex healthcare data transformations, generate SQL for dimensional modeling of our health event data mart, and create comprehensive test scenarios that covered edge cases in benefit utilization patterns. Carefully crafted prompts helped us navigate HIPAA compliance requirements, translating regulatory language into technical specifications and generating audit logging frameworks.

The AWS-based solution (EC2, Lambda, S3, RDS) achieved 100% on-time federal reporting while establishing our organization as a compliance leader. More significantly, our prompt engineering strategy reduced development time by 40%, allowing focus on strategic challenges such as converting compliance data into member communication triggers for unused benefits and building reusable components for future regulatory initiatives.

Key lessons include designing prompts that balance healthcare domain specificity with technical precision, iterating on AI-generated code to meet strict security standards, and using LLMs to bridge communication gaps between clinical, technical, and business stakeholders. We transformed a federal mandate into a single source of truth that eliminated redundant processing and enabled data-driven benefit decisions.

Attendees will learn practical prompt engineering techniques for regulated industries, strategies for AI-assisted architecture in complex integrations, and methods to accelerate compliance-driven solution delivery.

Summary

Transcript

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Hey guys. Thanks for joining me. This is ULA and I have around two decades of IT experience and most of my experience is providing healthcare solutions in cloud and ai. Today I would like to talk about a solution we recently implemented for a federal or CMS mandate where we support. More than 2 million Medicare member, and this mandate is about how do we ensure our Medicare members utilize their supplemental benefits? They are entitled, and even though they have enrolled and entitled, but most of them, they don't proactively leverage or utilize them. The goal of this federal mandate was to. Ensure organizations or Medicare organizations reach proactively these members asking them to understand what they are entitled for, what are pending supplemental benefits they can utilize, and what is the duration? So this is a mandate which was supposed to be implemented in 2024 December. So let's deep dive into it. So this initiative represents a pioneering case study in leveraging AI within the healthcare compliance setting, a new benchmark for efficiency and accuracy. Its successful implementation is POed to deliver transformative impact, reshaping industry standards and ensuring equitable benefit distributions for millions of members. So the challenge we had is the unprecedented data demands in 2024, as this was mandated, where our organization is supposed to understand more than a hundred supplemental benefits we support today, but currently. More than 10 different vendors, source systems are providing the services to the organizations. So how do we ensure that we gather all the information, we filter through the different benefits as these are complex benefits to understand they have their own structures. So the challenge is the data. How do we play around with the data? Understand different structures for these 200 plus. 2 million plus members. So this is the highlight of like in this project, what we have faced, where we had around 102 supplemental benefit, different benefits. Each has a distinct demand and istic categorized and standardized, and there are 10 different source systems. Integration of these systems and understanding each system to see what benefit they provide, how they are different from other source systems, maybe overlap between different systems. So that's another challenge we had. And we had two, two plus million members were supported using the Medicare organizations. Who are involved in medical as well as PDP or pharmacy benefits. So how the AI prompt help to solve our project. So our strategic eruption of prompt engineering and AI assisted development revolutionized the entire development life cycle, enabling. Unprecedented acceleration in solution delivery while rigorously upholding compliance and ensuring absolute accuracy across all the operations. Accelerated prototyping where harnessing large language models, we swiftly prototyped complex ll logic. Significantly compressing development, timely timelines and enabling rapid adoption to evolve healthcare data transformations optimized. SQL generations AI driven SQL Generation streamlined the dimensional modeling of our health event Data mart, ensuring superior performance, robust scalability, and imp impeccable data integrity for critical analytics enhanced test scenarios. Leverage AI leveraging AI v meticulously crafted comprehensive test cases, covering integrated edge cases in benefit utilization patterns to guarantee unpowered solution reliability and unwavering laboratory compliance. How the prompt engineering helped in being in HIPAA compliant, unlocking unparalleled security and regulatory, our prompt engineering. Expertise was pivotal navigating the landscape of HIPAA compliance through meticulously crafted prompts. We translated dense federal guidelines into a CRI crystal clear, actionable technical specifications. This accelerated the dynamic generation of robust audit logging frameworks and ENT data governance protocols, ensuring steadfast utterance to federal security standards from concept to deployment. This AI powered method methodology not only guaranteed unwavering patient data protection, but also significantly enhanced operations agility and drastically mitigated. Compliance risks solidify our, solidifying our commitment to secure responsible AI innovation in healthcare. So this is a high level like technical architecture or basically the background on, apart from the ai, what AWS services we use. We used EC2 instances and Lambda. These are serverless and scalable computing resources to efficiently process vast data sets, ensuring rapid data transformation and seamless integration for complex works. We leveraged s St S3 storage to establish a highly secure compliant data lake for comprehensive storage of raw and processed healthcare information optimized for accessibility, integrity, and long-term retention. RDS was leveraged, which is a highly reliable and high performance relational database to manage critical structured benefits and member data, enabling accurate reporting and insightful analytics for informed decision making beyond just a federal mandate. Our AWS based AI solution delivered. Unmatched scalability, iron Cloud, security, and unwavering reliability. Established in the Future Proof Foundation for critical data operations and driving innovations in patient care and compliance. This particular solutions set a benchmark being on percent or 10% on time. The success of this delivery across the industry demonstrated a new paradigm for operational rigor, accountability, inspiring others to elevate their standards. Furthermore, this Unpowered track record grant us strategic or significant computer advantage. Opening doors for strategic partnership and fostering sustained growth in rapidly evolving healthcare landscape. Unleashing the power of prompt engineering, how prompt engineering help in accelerated development cycles. Achieved a remarkable 40% reduction in overall development time by strategically implementing advanced prompt engineering techniques. Fostering agile and highly efficient project execution, ensure a proper hundred percent on time delivery rate for all federal reporting requirement, demonstrating our capability to streamline complex compliance process through innovative, prompt driven automation. Our prompt engineering framework empowered our team to pivot from tedious repeated coding task to a high value strategic initiative. This not only dramatically accelerated our delivery timelines, but also solidified our commitment to maintain the regard risk quality standards our client expects transforming compliance into strategic advantage. Unified Data Foundation where streamlined the operations and ensure the data integrated by establishing a single authority source of truth, eliminating redundant processing, and fostering accuracy. This helped in proactive member engagement, engagement and also future regulatory framework and in empowering strategic decisions where. Leveraging the newly enriched compliance data to provide a critical insights, empowering leaders to optimize benefits offerings, refined planning, and drive superior outcomes across the organization. Unlocking AI potentials critical in insights from our journey. So I would like to share how AI has helped in our journey and what can help others mastering prompt engineering. Tailored for healthcare AI crafting prompts that expertly blend deep healthcare domain knowledge with precise technical specifications proved essential, dramatically accelerating the generation of accurate, robust, and immediately usable code. Achieving around cloud security and stringent HIPAA compliance for AI generated code demanded the meticulous iterate to refinement, transforming raw output into the production ready, regulatory approved solutions, LLM as a strategic connectors unifying diverse teams. The LLM emerged as a powerful catalyst. Seamless bridging communication divides between clinical experts. Technical developers and business strategies fostering unprecedented alignment and accelerating project execution. Strategic prompt engineering, ensuring compliance healthcare, ai, applying AI responsibilities in highly regulated healthcare environments. Integrate HIPAA and industry specific regulation directly into prompt design, leverage precise legal and clinical terminology for clarity and accuracy. Demand comprehensive adult audit trails and documentation for traceability and accountability. Rigorously validate AI outputs against established security framework like NIST and ISO. Continuously refined prompts with clinical and legal experts to ensure patient safety and regulatory adherence. So this is a flow where, how the transformative AI helped our project or any generic project. So in the discovery phase. How it helped in the design phase, what we utilize. So in the discovery phase, harnessing AI powered LLMs to de deeply analyze the existing risk systems, revealing critical integration points and hidden dependencies to establish a robust architectural foundation employee to rapidly generate in issue architecture. Options in implementation, accelerate deployment. Cycles by AI driven prototyping. Prototyping of ETL pipelines and complex data transformations. Ensuring efficient, reliable deployment, leverage AI to ultimately generate comprehensive test scenarios, meticulously covering all edge cases to guarantee system stability and performance. Automate the generation of precise technical document and compliance report. Significantly reducing manual effort and ensuring audit readiness and clarity beyond compliance, driving value. Through strategic transformation, we didn't just meet a federal mandate. We leverage it as a catalyst to unlock significant value, dramatically boosting member engagement and achieving unparalleled operational efficiency. Unlocking tomorrow's health, AI's transformative power. We saw beyond many regulatory compliance harnessing advanced AI to not only meet the mandate, but fundamentally fundamental redefine how we deliver care. This isn't just a technology, it's about pioneering a smarter, more empathetic. Healthcare experience for every member. This initiative also created a broader impact on healthcare innovation, fostering culture of continuous implement and technological advancement across the organization. Furthermore, we established a scalable framework ready for future AI implementations, ensuring our ability to adopt and lead in the evolving landscape of medical technology. I would like to call some key takeaways from our implementation, how prompt engineering in AI help drive rapid innovation, leveraging prompt engineering slash development cycles up to 40%, and helped in high quality solutions and meeting. Project timelines or federal mandate on time. Master regulatory challenges utilize AI driven development to seamless translate regulatory requirements into robust cutting edge technical implementations. Unlock new growth revenues by redefining compliance from a burden to a strategic asset Fostering. Deeper member engagement and significant operational advancement. Equip yourself with advanced prompt engineering strategies designed for regulated industries, ensuring unparalleled security, precision, and adherence to all compliance standards for a future ready healthcare system. I hope this was helpful. Thank you.
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Bandanawaz Mulla

Senior Manager Platform Strategy @ Health Care Service Corporation ยท Full-time

Bandanawaz Mulla's LinkedIn account



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