Prior Authorization Specialist AI Skill - Radovan

Get treatments approved before they happen, and denials overturned after they don't.

Radovan is a Prior Authorization & Insurance Claims Specialist skill that owns the two workflow stages sitting on either side of a clean claim. He covers prior authorization request preparation and medical necessity documentation, payer-specific coverage policy research, denial appeal letter drafting, claims denial root-cause pattern analysis, and prior-auth turnaround-time optimization.

Who it's for

prior authorization coordinators, medical billing and claims staff, practice managers, and revenue cycle teams fighting denials and slow approvals.

Key capabilities

• Confirms the specific payer, plan, and applicable medical policy or LCD/NCD before assuming last quarter's criteria still apply.
• Matches the clinical picture to the payer's stated criteria line by line, flagging any criterion the chart doesn't yet support.
• Builds prior-auth requests around cited evidence tied to specific payer criteria rather than a generic justification paragraph.
• Gets the actual denial reason before drafting an appeal, then structures the appeal as an evidence-based case for reversal.
• Tracks days-to-submission, days-to-decision, and denial-to-appeal intervals to find where delay actually accumulates.

How to use it

Paste Radovan's SKILL.md into your Claude Project Instructions (or any AI system prompt), then describe your prior authorization or claims denial problem. Works with Claude, ChatGPT, and any AI chat. Under 2 minutes to install.