Prior authorization performance
Fix the workflow before you fund more automation.
TKO helps specialty medical groups and healthcare operators identify the operational causes of prior-authorization delays, denials, rework, and staff dependency—then turn the evidence into a practical 90-day improvement plan.
15 business days
$25,000 fixed fee
One defined PA workflow
Principal-led
The operating cost
The queue is the symptom. The cost starts earlier.
Prior authorization becomes expensive when incomplete intake, inconsistent documentation, payer-specific workarounds, unclear escalation, and manual follow-up compound across cases.
- Staff touch the same case repeatedly before it can move.
- Turnaround varies by payer, specialty, location, or employee.
- Denials are counted without separating avoidable operational causes.
- Experienced staff remain the only reliable escalation path.
- Automation is proposed before the workflow is stable enough to automate.
Start here
Prior Authorization Performance Diagnostic
A fixed-fee, 15-business-day engagement for one defined prior-authorization workflow or specialty/payer segment. Leadership gets a common fact base and a decision on what to fix, fund, automate, stop, or defer.
- Duration
- 15 business days
- Fee
- $25,000 fixed
You leave with
- A measured baseline and agreed KPI definitions
- A current-state workflow and exception map
- A denial, rework, handoff, and delay driver analysis
- Clear decision-rights and escalation gaps
- A target workflow and prioritized improvement backlog
- A 90-day roadmap and executive decision brief
15-business-day process
From competing explanations to one fundable decision.
The work starts with operating evidence. Automation or AI is considered only after the workflow, exceptions, decision rights, controls, and measures are understood.
01
Establish the baseline
Confirm the workflow, sponsor, decision, available evidence, and measures that matter.
02
Find the operating causes
Compare the documented process with actual routing, exceptions, workarounds, and payer- or specialty-specific variation.
03
Decide what changes next
Size responsible opportunity ranges, redesign the priority workflow, assign ownership, and sequence a 90-day plan.
20+ years in regulated operations
- Apollo Global Management, regulated operations and exception handling
- Sapient, institutional platform transformation
- ELLKAY, CMS Cures Act and FHIR interoperability
- Cognizant, healthcare transformation and payer operations
- Full career record
Employment history, not client endorsements. Each role is publicly verifiable on LinkedIn.
Relevant healthcare experience
Healthcare operating context, with the claim boundary stated.
Todd’s experience includes prior authorization and utilization-management workflows, payer/provider operations, CMS interoperability, delivery governance, and enterprise healthcare transformation. Employment history is not employer or client endorsement.
Prior authorization
Prior Authorization Workflow Modernization
Experience redesigning review tiers, escalation, auditability, and human approval so leadership could distinguish where machine assistance could help from where human judgment had to remain.
No client name, quantified outcome, or employer endorsement is claimed.
Review the ExperienceHealthcare interoperability
Governance Embedded in Workflow
Payer-facing CMS interoperability work connected technical exchange to onboarding, access control, auditability, and operating governance.
This establishes relevant operating experience, not a claimed TKO client result.
Review the ExperienceDiagnostic follow-on
90-Day Prior Authorization Improvement Sprint
If the Diagnostic establishes a credible baseline, accountable owner, and measurable opportunity, TKO can stay through one bounded implementation and controlled pilot.
- Duration
- 12 weeks
- Typical fee
- $65,000–$95,000
Redesign one priority workflow, make ownership and escalation explicit, establish measures, pilot the change, and hand it to the team. Automation or AI is used only where the evidence and control model support it.
Discuss the 90-Day SprintA good fit
- Prior-authorization performance is an active operating or revenue priority.
- One executive owns the decision.
- Basic volume, denial, turnaround, payer, specialty, and staffing evidence is available or can be assembled.
- Leadership is prepared to act on the result.
Not a fit
- General interest in AI without a defined workflow.
- A request for outsourced PA staffing or a software platform.
- A search for guaranteed savings or denial reduction before a baseline exists.
- An enterprise-wide transformation scope without a bounded starting point.
Diagnostic fit call
Bring the prior-authorization workflow leadership needs to improve.
Share what changed, where performance is under pressure, and what decision is approaching. Todd will reply within one business day and, if there is a plausible fit, schedule a 30-minute working conversation.