Product Analyst – Eligibility, Benefits & Estimates at RevSpring

Nashville, Tennessee, United States -

Full Time

Start Date

Immediate

Expiry Date

04 Aug, 26

Salary

0.0

Posted On

06 May, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

EDI 270/271, Revenue Cycle Management, Patient Access, Patient Responsibility Estimation, Functional Specifications, User Story Writing, CMS Hospital Price Transparency, Payer Connectivity, Benefit Verification, Data Analysis, Product Analysis, Healthcare IT

Industry

Information Technology & Services

Description

Product Analyst – Eligibility, Benefits & Estimates About the Role 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. What You'll Do Eligibility & Benefit Verification • 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 Estimate Calculation • 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 Hospital Price Transparency • 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 CMScompliant 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 Cross-Functional & Client-Facing Work • 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 realworld 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 You Bring Required • 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 Preferred • 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 #LI-DNI #LI-DNP

Responsibilities

The role focuses on analyzing eligibility and benefit verification (EBV) workflows and patient responsibility estimate calculations. It also involves supporting hospital clients with CMS-compliant price transparency tools and machine-readable file generation.