Automation Assistant

Healthcare Claims Automation

Revenue Cycle Management

Product Backlog & Prioritization

User stories ranked by value, complexity, and priority

Backlog Overview
This backlog demonstrates how I would prioritize features for a claims automation product. Stories are ranked using a value-complexity matrix, considering business impact, user needs, and technical feasibility.
US-001P0
As a billing specialist, I want automated risk scoring on claims so that I can prioritize high-risk claims for review
Acceptance Criteria

Risk score visible on claim detail page; Claims sortable by risk level; Score updates in real-time

Value:High
Complexity:Medium
US-002P0
As a revenue cycle manager, I want pre-submission validation rules so that claims are checked before they go out
Acceptance Criteria

Rules engine configurable by admin; Validation runs on save/submit; Errors displayed with clear messaging

Value:High
Complexity:High
US-003P1
As a billing specialist, I want workflow alerts for missing data so that I can fix issues before submission
Acceptance Criteria

Alerts show on claim form; Contextual guidance provided; Alert dismissible after resolution

Value:High
Complexity:Low
US-004P1
As a billing specialist, I want real-time eligibility checks so that I know coverage status before submitting
Acceptance Criteria

Eligibility check button on claim form; Results displayed within 3 seconds; Status saved with claim

Value:High
Complexity:Medium
US-005P2
As a standardization lead, I want a payer rule library so that we enforce consistent validation across facilities
Acceptance Criteria

Admin interface to manage rules; Rules mapped to payers; Version control for rule changes

Value:Medium
Complexity:High
US-006P2
As a revenue cycle manager, I want an automation coverage dashboard so that I can track automation adoption
Acceptance Criteria

Dashboard shows % of claims automated; Drill-down by facility and payer; Export to CSV

Value:Medium
Complexity:Medium
US-007P2
As an operations director, I want an automation intake form so that teams can request new automation opportunities
Acceptance Criteria

Form captures workflow area, pain points, and ROI; Submissions stored in database; Admin review queue

Value:Medium
Complexity:Low
US-008P1
As a billing specialist, I want intelligent claim routing so that claims automatically go to the right queue
Acceptance Criteria

Claims route based on risk score and payer; Manual override available; Audit log of routing decisions

Value:High
Complexity:Medium
US-009P2
As a standardization lead, I want standardization mapping tools so that we normalize data across systems
Acceptance Criteria

Mapping interface for codes and values; Bulk import/export; Change history tracking

Value:Medium
Complexity:High
US-010P1
As a revenue cycle manager, I want denial pattern analytics so that I can identify recurring issues by payer
Acceptance Criteria

Dashboard shows top denial reasons; Filterable by payer and date range; Trend analysis over time

Value:High
Complexity:Medium
Priority Legend
P0

Critical - Ship immediately

P1

High - Next sprint

P2

Medium - Future iteration