Leveraging AI Solutions to Modernize Prior Authorization in Medical Practices, with Dr. Paola Ballester

In this episode of the MGMA Insights Podcast, Sr. Editor and host Daniel Williams sits down with Paola Ballester, MD, pediatric hospitalist, medical director for utilization management, and senior physician advisor at a large, freestanding academic children’s hospital and regional pediatric referral center. Dr. Ballester is also the co-founder of EasyPA, an AI-driven platform designed to streamline prior authorization processes. Together, they explore how medical practices can tackle administrative burdens, leverage technology, and prepare for upcoming regulatory changes — all while improving patient access to care.Key Takeaways02:45 Dr. Ballester’s Unique Journey From insurance claims adjuster to pediatric hospitalist — how her background shaped her expertise in utilization management and revenue cycle.06:27 The Pain Points of Prior Authorization Why delays in prior auth lead to patient suffering and staff frustration, and why the current system is broken. 08:01 Introducing EasyPA How an AI-powered platform can detect prior auth requirements, reduce denials, and generate appeal letters and peer-to-peer talking points. 11:37 The “220-Minute Case” A real-world example of administrative burden: 19 email threads, 14 team members, and multiple failed appeals for one procedure.22:19 Preparing for Regulatory Changes CMS’s new rules (57F) will require electronic prior auth by Jan 1, 2027 — what practices need to know now. 17:22 Choosing the Right Tech Tools Practical advice for administrators and clinicians on evaluating AI solutions and understanding your own data before investing.24:22 Leadership and Representation Dr. Ballester’s advice for women in healthcare leadership: owning confidence, overcoming imposter syndrome, and defining success. 26:35 Life Beyond Medicine How being a basketball mom keeps Dr. Ballester grounded and why setting boundaries matters for work-life balance. Resources & LinksEasyPA Reach out to Paola Ballester, MD, on LinkedInCMS Rule 57F - Details on upcoming electronic prior authorization requirements.MGMA prior authorization resources Allied Medical Waste is the premier medical waste and document shredding company for medical groups all over the United States. On average, Allied helps medical groups save up to 50% on their monthly costs. Allied is known for their great service and impeccable response times. Reach out today for a free quote! Allied has a special offer for all MGMA members: the first 2 months FREE of charge!Connect with us at [email protected] or call (801) 328-8581.