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 Takeaways

• 02:45 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 & Links

• EasyPA
• Reach out to Paola Ballester, MD, on LinkedIn
• CMS Rule 57F - Details on upcoming electronic prior authorization requirements.
• MGMA prior authorization resources

This episode is sponsored by ModMed.
Every denied claim costs time and money to rework — for care you’ve already delivered. While payers sharpen their own AI tools, ModMed RCM Services pairs seasoned billing specialists with AI designed to help flag claims at risk before they go out the door, so your team can fix issues upfront instead of appealing after the fact. Learn more here.