How a Regional Hospital Reclaimed 30,000 Clinical Hours With Automated Prior Authorization Workflows

When a new clinical leader stepped in, she didn’t just restart the program, she refocused it entirely. With a renewed emphasis on centralized operations, staff enablement, automation and measurable results, the hospital restarted the pilot and transformed its fragmented prior authorization process into a lean, scalable, high-performing function.

“We couldn’t do what we do without Infinx. They’re the reason our small team of five can handle a workload that used to take 88 people.”
—Quality Coordinator & Prior Auth Leader

Prior to working with Infinx, the hospital’s prior auth process was anything but efficient. It was distributed across 88 employees (nurses, schedulers, care teams) each using slightly different methods with little documentation or oversight. As volume rose, so did denials, phone tag with payers, and staff burnout. Common challenges included:

• 88 team members, mostly clinical staff, involved in prior auth, each using different processes
• Skepticism toward automation as a threat, not a workflow enabler
• No data visibility to track ROI or success
• Denials increasing due to front-end and post-service errors
• Expansion into imaging, sleep, rehab, and surgery increased prior authorization workload

“Our clinicians were stuck arguing with insurance companies. Now they’re doing what they were trained for – caring for patients.”

Rather than forcing a one-size-fits-all model, the department leaders worked with Infinx to tailor solutions for each clinical workflow. The engagement started with weekly tactical check-ins and quickly evolved into a strategic collaboration.

Key elements of the transformation included:

• Automation aligned with real clinical workflows
• Support spanning imaging, surgery, cardio-pulmonary, sleep, rehab, and bariatrics
• Flexible resourcing for manual intervention through onshore and offshore teams
• Weekly meetings transitioned to biweekly, then monthly, once workflows stabilized

“We’ve asked Infinx to help with complex, oddball processes—and they’ve figured it out every time.”

With centralized workflows and automation in place, the hospital didn’t just fix the workflow; it scaled. Patient access operations became more mature and predictable, turnaround times improved, and staff were no longer stuck in reactive mode.

Employees working on prior authorizations reduced by 94.3%, from 88 fragmented roles to 5 high-performing team members.

“We couldn’t do what we do without Infinx. They’re not just helping us get by. They’re the reason our small team of five can handle a workload that used to take 88 people.”

Imaging services can now be handled by a single coordinator. Additional service lines like surgery, sleep studies, rehab, and cardiopulmonary were absorbed without hiring new employees.

“One person used to manage PAs for 7 surgeons. Now they handle 30 without adding staff.”

Clinical staff regained 5 to 10 hours per week—time now spent on patient care, not paperwork.

“Infinx gave 82 clinical staff members back 5 to 10 hours a week. That’s thousands of hours redirected from phone calls with insurers to patient care.”

With proactive validation and stronger documentation, pre-surgical and post-procedure denials dropped significantly. Prior authorization performance is now trackable by service line and team, enabling revenue cycle leaders to make informed decisions with real-time visibility.

What began as a stalled pilot has become a scalable, operating system now trusted across the hospital organization.

Instead of reacting to frequent payer issues, the team is proactive, confident, and working in lockstep with Infinx as a strategic extension of their own patient access team.