Healthcare Pricing, Direct Pay Specialist

🔥 3 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

👻 Ghost score 15%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Frontier Direct Care

WebsiteLinkedInAll Job Openings

11 - 50 employees

🏥 Healthcare

⚕️ Healthcare Insurance

🛡️ Insurance

Healthcare • Healthcare Insurance • Insurance

Frontier Direct Care is dedicated to transforming healthcare for families, individuals, and businesses. They specialize in family practice, direct primary care, and diabetes management, offering a model that eliminates long wait times, insurance complications, and hidden costs.

📋 Description

• Review clinical referrals, orders, and chart notes to verify exact CPT, HCPCS, and ICD-10 codes • Identify all associated billing components for specialist visits, diagnostics, imaging, injections, and outpatient procedures • Separate or bundle professional/physician fees, facility/ASC fees, anesthesia, pathology, labs, and DME to prevent surprise bills • Contact specialist offices, imaging centers, labs, and surgical facilities to obtain written self-pay and prompt-pay fee schedules • Build Provider Option Slates covering pricing, location, availability, and payment terms for Care Navigators • Cross-check services and CPT codes against employer/sponsor health plan guidelines and clinical criteria to verify cash-pay eligibility • Negotiate fair cash rates, global surgical/procedure bundles, and Single Case Agreements with clinic practice managers, surgery centers, and hospital financial counselors • Benchmark provider quotes against Medicare baselines, clinic fee schedules, and historical fair-market cash rates • Serve as the pricing and billing resource for Care Navigators on complex referrals • Troubleshoot point-of-service billing issues so members are not asked to pay out of pocket or turned away • Execute timely direct payments for specialist care, imaging, therapies, and procedures and reconcile payment documentation

🎯 Requirements

• 2–4+ years of experience in healthcare revenue cycle, medical billing/coding, upfront patient financial counseling, surgical/procedure cost estimation, direct provider contracting, or TPA/self-funded plan pricing • Strong working knowledge of CPT, HCPCS, and ICD-10 codes • Ability to read a clinical order and identify applicable CPT codes • Understanding of global surgical periods, common modifiers, and facility vs. professional billing splits • Hands-on familiarity with cash-pay/self-pay processes, including self-pay estimates, prompt-pay discounts, fee schedules, or Single Case Agreements (SCAs) • Comfort executing point-of-service payments via virtual credit cards, ACH, checks, or payment portals and reconciling itemized superbills/receipts • Proven ability to negotiate with billing managers and revenue cycle directors and secure written rate confirmations quickly • Ability to manage high-volume daily task queues, including same-day check-ins and multi-day pricing research, in an EHR/ticketing system • Active coding or revenue cycle certification (CPC, CPB, CCS-P, CRCR, or equivalent) or equivalent hands-on specialty clinic/ASC financial estimation experience • Experience in Direct Primary Care (DPC), Direct Contracting, Reference-Based Pricing (RBP), surgical bundles, or self-funded employer health plans • Background in multi-specialty outpatient settings such as orthopedics, GI, cardiology, general surgery, advanced radiology, or outpatient surgery centers • Bilingual English/Spanish is a plus

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