Healthcare specialization
Prior authorization is the commercial focus. Healthcare operating experience is the foundation.
TKO works with specialty medical groups, MSOs, and provider-side healthcare operators when prior-authorization delay, rework, denials, inconsistent payer handling, or staff dependency is creating an expensive operating problem. The first engagement is a 15-business-day Diagnostic—not a broad transformation program or technology pitch.
Primary specialization
Provider-side prior-authorization performance
Starting engagement
15 business days · $25,000 fixed fee
Operating principle
Fix the workflow before funding more automation
Recognizable operating problems
The technology layer is only one part of the work.
Prior authorization is the entry wedge because it makes the operating failure concrete and measurable. Related healthcare experience matters when it helps leadership understand workflow, evidence, authority, controls, and implementation—not as a separate menu of services.
Prior authorization
Requests move through inconsistent intake, documentation, payer handling, follow-up, exception, and escalation paths. The cost appears as delay, rework, denials, backlog, and dependence on experienced staff.
Utilization management
Review work depends on complete evidence, explicit prioritization, defined decision authority, and reliable escalation. Technology does not resolve those operating requirements by itself.
Interoperability
FHIR and data exchange can improve information availability. They do not determine who owns the next action, how conflicting evidence is resolved, or how exceptions move through the operating workflow.
Administrative transformation
Programs stall when workstream status hides cross-functional dependencies, adoption risk, and decisions that no single team owns. The same problem appears inside a PA workflow at a smaller scale.
Why Todd is relevant
Operations, product, regulation, technology, and implementation in one operating view.
The credibility is the intersection, not a claim that every prior role produced a publishable client result. Employment history establishes experience. Selected Work states the available evidence and its limits.
Prior authorization and utilization management
Experience with payer/provider coordination, review tiers, exceptions, escalation, auditability, and human decision points.
Healthcare interoperability
Verified product ownership covering CMS Cures Act, FHIR, access control, auditability, governance, and payer-facing requirements.
Enterprise healthcare transformation
Experience in delivery governance, executive reporting, dependency management, workflow transformation, and AI-enabled operating improvement.
Implementation under controls
RachelOS supplies inspectable, non-healthcare evidence of workflow design, source authority, human approval, operating health, and bounded AI assistance.
What the Diagnostic resolves
A client-specific baseline before an implementation decision.
The engagement stays within one organization and one defined PA workflow or specialty/payer segment. It produces evidence leadership can use whether TKO implements the next step or not.
- Where does a request first become incomplete, delayed, or likely to require rework?
- Which payer, specialty, location, or exception patterns explain meaningful variation?
- Where do experienced staff compensate for unclear standard work or escalation?
- Which measures are credible enough to govern a 90-day improvement?
- What should be standardized, controlled, automated, or deliberately left under human judgment?
Regulatory context
Interoperability requirements increase the need for operating clarity.
CMS-0057-F advances prior-authorization process and API requirements for impacted payers. That technology and policy context is important, but it does not replace provider-side workflow design, evidence quality, exception handling, ownership, or adoption.
Diagnostic fit call
Bring one prior-authorization workflow under pressure.
If leadership needs to understand the operating causes before making another technology, staffing, or vendor decision, request a Diagnostic Fit Call.