Tanveer T

Project: Utilization Management & Prior Authorization System Implementation

Description: The Utilization Management (UM) & Prior Authorization System Implementation project aimed to improve the efficiency of prior authorization (PA) requests by automating workflows and integrating with EHR/EMR systems for real-time approvals. It ensured compliance with CMS Medicare Advantage, Medicaid, and ACA regulations while streamlining step therapy and peer review processes. The system utilized InterQual and MCG guidelines for medical necessity determinations, reducing manual effort for healthcare providers. My role involved defining business rules, vendor selection, data mapping, and UAT execution, leading to a more efficient and compliant PA process.

• Worked closely with UM nurses, medical directors, and compliance teams to gather business requirements and define workflows for prior authorization (PA) processing.
• Defined KPI dashboards in Power BI/Tableau, tracking PA approval rates, turnaround times, and provider compliance metrics.
• Used SQL queries to analyze claims, authorization, and eligibility data, validating correct mapping between source and target systems.
• Worked on data validation scripts, ensuring accuracy in authorization records, claims processing, and eligibility verification.
• Used JIRA/Azure DevOps to log defects, track issues, and work with developers to resolve data discrepancies, API failures, and UI bugs.
• Developed and executed test cases for PA workflows, validated system outputs with business users, and assisted in production deployment.
• Wrote and optimized SQL queries for extracting, transforming, and loading (ETL) authorization data from legacy systems to the new platform while ensuring data integrity and consistency.
• Created and maintained detailed requirement documents, system workflows, and business process diagrams in Confluence, providing a centralized knowledge base for all stakeholders.

Project: Treasury Management System Implementation

Description: The Treasury Management System Implementation project focused on optimizing cash flow, liquidity forecasting, and managing foreign exchange risk for corporate banking clients. It integrated real-time cash positioning, automated sweep accounts, and streamlined interbank fund transfers using SWIFT messaging. The system was connected to core banking systems via APIs for seamless fund transfers and featured role-based access control for secure transactions. Additionally, the project ensured Basel III compliance through liquidity reporting to meet regulatory requirements. This implementation enhanced operational efficiency and financial decision-making.

• Gathered and analyzed requirements from corporate banking clients to enhance cash flow optimization, liquidity forecasting, and foreign exchange risk management using the TMS.
• Created detailed user stories and acceptance criteria in JIRA, ensuring clear communication of business requirements for development and testing teams.
• Designed regulatory-compliant reports in Confluence and Power BI, focusing on Basel III liquidity requirements to support financial institutions’ reporting obligations.
• Led user acceptance testing (UAT) efforts using JIRA to track and resolve defects, ensuring the TMS met both business requirements and regulatory standards.
• Facilitated sprint planning, daily standups, and retrospectives as part of an Agile Scrum team, ensuring timely delivery of functional features within each sprint.
• Coordinated with external vendors and third-party service providers to ensure smooth integration of payment processing systems, such as SWIFT messaging and fund transfer protocols.
• Utilized Confluence to document business requirements, system workflows, and process diagrams, providing a centralized knowledge base for all project stakeholders.
• Performed gap analysis between existing treasury systems and the new TMS, identifying opportunities for process automation and recommending system improvements to enhance operational efficiency.
• Assisted in the creation and refinement of test cases in JIRA/Xray, supporting UAT efforts to ensure the system’s functionality aligned with business and regulatory requirements.