Prior Authorization Is broken. We fixed it. Here's what nobody talks about.
- jibyjohn
- Mar 1
- 2 min read
Updated: Mar 5
18 months ago, I walked into a room full of skeptics.
The problem was simple to describe and brutal to live with. Prior authorizations were taking 4-6 days on average. Patients were waiting. Providers were frustrated. Revenue was bleeding. And everyone had already tried to fix it.
"We've been here before." That's what one of the senior directors said to me in the first meeting. Not aggressively, just tired. The kind of tired that comes from watching good ideas die in committee.
I understood the skepticism. I really did.
But I also saw something others had missed. This wasn't a technology problem. It wasn't a process problem either. It was a people and technology problem - and nobody had ever attacked both at the same time.
So we built a cross-functional team. Not the usual suspects. I pulled in clinicians, coders, ops leads, and front-line staff who actually lived with the pain every single day. People who had never sat in the same room together.
The first few weeks were messy. Uncomfortable. People had opinions. Old frustrations surfaced. There were moments I honestly wasn't sure it would hold together.
But something shifted around week six.
The clinicians started finishing each other's sentences with the tech team. The ops leads stopped defending their turf and started solving problems. We stopped talking about the authorization process and started redesigning it from scratch, together.
90 days later, our average auth turnaround dropped from 6 days to under 24 hours.
The same director who told me "we've been here before" pulled me aside after we presented the results. He didn't say much. Just, "I didn't think this one would work either."
That stuck with me.
The biggest barrier to solving hard problems is rarely the problem itself. It's the accumulated weight of every failed attempt that came before you.
Sometimes the most important thing a leader can do is walk into a tired room and refuse to be tired.
If you're in the RCM space and fighting this battle right now, I see you. It is not always a technology solution, but It is solvable. But not alone.