Overview
A third – party prior authorization company is interested in better understanding what could be improved within their prior authorization process. Analysts have been tasked with identifying areas of improvement in order to increase revenue and decrease denials.
Data & Tools
The data was provided in a xls file. The attributes in the dataset includes PAL Category, Procedure Code, Policy, Authorization Number, Submission Date, Outcome, Reason and Cost. The data was analyzed primarily in Tableau Desktop.
Methodology
The exploratory data analysis was conducted in Tableau Desktop. And was guided by pressing questions from stakeholders and leadership to identify the root cause of lost revenue and prior authorization denials. This included identifying departments with the highest denials or the most revenue lost and which PAL category has the highest denials. This information is an opportunity to identify areas in the prior authorization workflow that commonly results in errors. The metrics below can be modified to strive for continuous improvement or monitored as a benchmark to show measurable results ongoing.