Product Analyst – Eligibility, Benefits & Estimates

RevSpring • Nashville, TN

4d

About The Position

The Preservice business unit owns the patient access workflow from first contact through financial clearance. This Product Analyst role is embedded in the core of that workflow; specifically, the systems that determine what a patient's insurance will cover and what they'll owe before they ever walk through the door. You will work alongside an established product team focused on two tightly coupled capabilities: eligibility and benefit verification (EBV) and patient estimate calculation.

Requirements

• 5+ years in a product analyst, business analyst, or functional analyst role within healthcare IT, specifically revenue cycle, patient access, or payer/provider operations
• Direct, hands-on experience with EDI 270/271 transactions - not just awareness, but the ability to read a 271 response and diagnose what a payer returned and why
• Working knowledge of patient responsibility estimation including how benefit structures (deductibles, coinsurance, copays, OOP limits) interact with charges and fee schedules
• Familiarity with clearinghouse relationships, real-time eligibility APIs, and payer connectivity models
• Ability to write detailed functional specifications and translate ambiguous business requirements into precise, testable user stories

Nice To Haves

• Experience with DRG-based or APC-based estimation, or familiarity with grouper logic
• Exposure to coordination of benefits (COB) workflows and secondary payer scenarios
• Familiarity with CMS Hospital Price Transparency requirements, including MRF schema specifications and standard charge display obligations
• Familiarity with FHIR-based eligibility standards (Da Vinci Coverage Requirements Discovery, etc.) as payer mandates evolve

Responsibilities

• Collaborate with the team to analyze payer EDI 270/271 transaction flows, including segment-level response interpretation, benefit category mapping, and exception handling for non-standard payer responses
• Assist in documenting and maintaining payer-specific behavioral rules, network tier logic, accumulator data (deductibles, OOP maximums, coinsurance), and coordination of benefits scenarios
• Work closely with engineering and integrations teams on payer connectivity issues and clearinghouse relationships
• Track payer response quality metrics and surface actionable insights to product and client success teams
• Work alongside the team on the functional logic behind patient responsibility estimates, including charge-based and fee schedule-driven estimation, benefit application sequencing, and prior accumulator incorporation
• Analyze estimation accuracy rates by payer, plan type, service type, and facility and collaborate with product and engineering to drive improvement
• Understand how DRG-based vs. CPT/APC-based estimation methodologies affect accuracy and communicate those tradeoffs clearly to internal and external stakeholders
• Support configuration and rules management for estimate engines, including payer plan configuration, service-to-benefit mapping, and financial class logic
• Support hospital clients in configuring the price transparency estimation tool, including standard charge mapping, item and service setup, and payer-specific negotiated rate configuration
• Collaborate with the team on the functional requirements and validation of CMS-compliant machine-readable file (MRF) generation, ensuring correct schema structure, required data elements, and accurate representation of a hospital's standard charges
• Help identify and resolve configuration issues that result in MRF output errors or incomplete charge data
• Stay current on CMS Hospital Price Transparency enforcement guidance and schema updates, and surface compliance implications to the broader product team
• Support client-facing teams with onboarding, configuration questions, and issue resolution specific to the hospital price transparency product
• Work closely with the Product Owner to support sprint and release planning, including contributing to backlog refinement, writing and decomposing user stories, and ensuring engineering work is well-defined and ready for development
• Translate complex EBV, estimation, and price transparency logic into clear, actionable product requirements and user stories
• Partner with implementation, client success, and revenue cycle SMEs to understand real-world workflow breakdowns and convert them into roadmap input
• Conduct analysis on production data to diagnose accuracy issues, identify trends, and measure the impact of product changes

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed