Oncospark
Reducing Revenue Loss from Denied Claims
Summary
When Medicare denies a claim, it's usually because the documentation doesn't clearly justify why the procedure should be covered. With only 1 in 10 denials ever appealed, surgical clinics lose thousands in recoverable revenue. My team helped reimagine the appeal process to change that.
My Contribution
As the sole product designer on this contract project, I worked alongside a business strategist and 2 engineers to design an AI-assisted Prior Authorization Dashboard, from surfacing denied claims to auto-generating appeal letters, validated directly with clinic staff.
Timeline
From August 2025 to December 2025
Team
1 Product Designer
1 Business Strategist
2 Engineers
Tools
Figma Agent
Claude Code
Vercel
VSCode
Skills
User Research
Prototyping
Usability Testing
Full Stack
Millions Lost to Preventable Denials
A Manual, multi-Step appeal process
Without centralized denial tracking, healthcare professionals spend 13+ hours each week identifying denied claims, decoding denial reasons, gathering documentation, and drafting appeals.
By the Numbers
4.1 million denials
Prior authorization requests denied by Medicare Advantage insurers in 2024.
13+ hours/week
Spent by physicians and staff completing prior authorization requirements.
Only 11.5% appealed
Yet 80.7% of appealed Medicare Advantage denials were overturned
We mapped the existing appeal workflow to understand where staff were losing the most time.
Our research showed that the biggest bottleneck came after a claim was denied. Staff had to manually interpret denial codes, gather supporting documentation, and build appeals from scratch, often without clear guidance on what would make an appeal successful.
We mapped the current claim denial workflow to find where staff lose the most time.
Secondary market research showed tools like CoverMyMeds help large hospitals manage billing, but don't give smaller surgical clinics an integrated way to track denials, understand why claims are rejected, and file appeals in one place. No existing solution uses AI to interpret denial patterns or generate appeal responses.
Solution
Automated Claim Denial Workflow
An AI-powered prior authorization platform that turns denied claims into actionable appeals, helping clinical staff understand why a claim was denied, build an evidence-backed response, and manage the appeal from denial through submission.
Core Functionalities
AI-powered denial analysis
Cited AI appeal generation
Pulls relevant clinical documentation to draft an evidence-backed appeal letter
End-to-end appeal tracking
Guides staff from denial through submission while predicting approval likelihood.
We mapped the current claim denial workflow to find where staff lose the most time.
Secondary market research showed tools like CoverMyMeds help large hospitals manage billing, but don't give smaller surgical clinics an integrated way to track denials, understand why claims are rejected, and file appeals in one place. No existing solution uses AI to interpret denial patterns or generate appeal responses.
The Updated Appeal Process
Staff begin by reviewing the denied claim and required documentation, with available records automatically pulled from the EHR. The system then drafts an appeal letter with inline citations for staff to review and edit before submission. Finally, staff can submit the appeal and track its status, with predicted approval and completeness checks surfaced throughout the process.
Prioritizing which case denials need attention first
Instead of scanning claims one by one, staff can see revenue at risk, approaching deadlines, and denial reasons in one place. Expanding a claim surfaces the context and required documents needed to decide what to appeal and begin the process directly from the dashboard.
Outcome
From a manual, hours-long process to an AI-assisted workflow adopted by clinical operations leadership.
The Prior Authorization Dashboard was approved for development by OnCoSpark's clinical operations leadership. In usability testing, 7 of 8 participants said they'd find the tool incredibly valuable if deployed, and the project was recognized with 2nd place at the 2025 Fung Engineering Health Innovation Competition.
Reflection
Denied claims aren't just paperwork, they're real revenue clinics depend on.
This project taught me how much of a healthcare workflow's complexity lives in the small, unglamorous details, a missing CARC code lookup, an unclear deadline, a document nobody flagged as required. Designing for staff working under time pressure meant every screen had to answer "what do I do next" without making them think. Translating that complexity into a system real clinics could trust and adopt required as much research and stakeholder alignment as it did craft.
