Healthcare Direct Pay Pricing Specialist

Frontier Direct Care, LLC; United States; On-site; USD 90,000 - 120,000; Full time

Job summary

Frontier Direct Care is seeking a detail-oriented Healthcare Pricing & Direct Pay Specialist to join our Pricing & Direct Pay pod. You will translate clinical orders into CPT codes, source upfront self-pay quotes, verify plan cash-pay eligibility, and execute direct payments so members experience zero billing friction.

The role sits at the intersection of medical coding and provider contracting, requiring strong CPT/HCPCS/ICD-10 knowledge, negotiation skills, and high organizational urgency

Qualifications

• Proficient in CPT/HCPCS/ICD-10 codes and global surgical pricing.
• Experience estimating cash-pay, prompt-pay discounts, and SCAs.
• Ability to negotiate upfront pricing with clinics and hospitals.

Responsibilities

• Verify CPT/HCPCS/ICD-10 codes for orders and referrals.
• Calculate full episode costs including professional and facility fees.
• Source self-pay quotes and create Provider Option Slates.
• Verify cash-pay eligibility against plan guidelines.
• Negotiate all-inclusive rates and Single Case Agreements.
• Collaborate with Care Navigators and resolve billing issues at DOS.

Skills

CPT/HCPCS/ICD-10 knowledge

Cash-pay pricing & negotiations

Billing & revenue cycle experience

Phone & written negotiation

Operational urgency & organization

Education

CPC/CPB/CCS-P or equivalent certification

Direct Primary Care / self-funded plan pricing experience

Tools

EHR system

Billing software

DOS/payment systems

Job description

Frontier Direct Care is seeking a detail-oriented Healthcare Pricing & Direct Pay Specialist to join our Pricing & Direct Pay pod. You will translate clinical orders into CPT codes, source upfront self-pay quotes, verify plan cash-pay eligibility, and execute direct payments so members experience zero billing friction.

The role sits at the intersection of medical coding and provider contracting, requiring strong CPT/HCPCS/ICD-10 knowledge, negotiation skills, and high organizational urgency