Jordan Leahy
Back to Work

PrescriberPoint

Drug Prior Authorization

PriorAuthMLWorkflowFormularyAutomation
01
The Team
1

My Role

Senior UX Designer

  • Workflow design & user research lead
  • Prior authorization workflow research
  • AI assisted interface design
  • Insurance integration UX strategy
2

Stakeholders

  • 2 Healthcare Workflow Specialists
  • 4 Backend Engineers
  • 1 ML Engineer
  • Product Manager
3

Scope

6 months

  • 8 major formulary integrations
  • AI rule extraction system
  • Automated letter generation workflow
  • Approval tracking dashboard
4

Tools

FigmaWhimsicalJira
02
The Challenge

The Inefficiency

1

Process Inefficiency

Average response time was 2-3 days, delaying patient care.
2

Provider Burden

78% of providers report prior authorization as a major workflow burden.
3

Integration Friction

60% of authorizations require multiple submissions due to complex, fragmented payer requirements.
03
The Process

From Analysis to Automation

1

Workflow Analysis & Research

Shadowed NPs and MAs to map deep user journeys.
Analyzed 10 formulary rule sets and interviewed insurance reviewers to identify pain points.
2

AI Assisted Workflow Design

Designed intelligent automation that identifies AI decision points while maintaining 'human-in-the-loop' oversight for exception handling.
3

Prototyping & Validation

Conducted iterative usability testing with prescribers using interactive prototypes with real data.
Validated formulary accuracy with MA reviewers.
4

Implementation & Optimization

Phased rollout across Florida dermatology practices.
Monitored performance and iterated based on real usage feedback.
04
The Solution

Intelligent Authorization

1

Formulary Identification

AI-powered analysis of insurance documents automatically identifies specific prior authorization requirements.
2

Medical Requirements

Surfacing all necessary medical documentation upfront to prevent denials.
3

Step Therapy Engine

Flagging 'try and fail' requirements (Step Therapy) before submission so providers can document history.
4

Reauthorization Intelligence

Tracking renewal dates to proactively alert staff before coverage lapses.
5

Automated Submission

One-click download and packet generation for mailing, faxing, or portal submission.
05
The Impact

3 Days to 5 Minutes

1

Velocity

"We went from 3 days to 5 minutes for specialty medication prior authorizations."
2

Patient Access

"Our patients get their medications faster, and our staff can focus on patient care instead of paperwork." — Maria Gonzalez, Medical Practice Manager.
06
Reflection & Learnings

The Retrospective

1

What Went Well

Multi-stakeholder research provided comprehensive requirements, and AI integration truly enhanced (rather than replaced) human expertise.
2

Challenges

Managing insurance API inconsistencies required creative workarounds, and regulatory compliance was complex.
3

Next Steps

Expanding to specialty medication prior authorizations and integrating directly with EHR systems.