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

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