[Hiring] Healthcare Pricing & Direct Pay Specialist @Frontier Direct, LLC

Role Description

Frontier Direct Care is transforming healthcare delivery by combining accessible primary care with proactive, white-glove Care Navigation. We are seeking a detail-oriented Healthcare Pricing & Direct Pay Specialist to join our Pricing & Direct Pay pod. You will partner closely with our Care Navigators to ensure members receive faster, friction-free care.

Key Responsibilities

• CPT Code Verification & Upfront Cash Pricing
  • Translate Orders into Accurate CPT Breakdowns: Review clinical referrals, orders, and chart notes to verify exact CPT, HCPCS, and ICD-10 codes.
  • Identify Full Episode Costs (Unbundled vs. Bundled): Anticipate all associated billing components before a patient is scheduled.
  • Source Self-Pay Quotes & Provider Options: Contact specialist offices, imaging centers, labs, and surgical facilities to obtain written self-pay/prompt-pay fee schedules.
  • Verify Plan Cash-Pay Eligibility: Cross-check requested services and CPT codes against employer/sponsor health plan guidelines.
• Complex Care, Bundled Pricing & Single Case Agreements (SCAs)
  • Negotiate All-Inclusive Rates & SCAs: Partner with clinic practice managers and hospital financial counselors to negotiate fair cash rates.
  • Benchmark Pricing: Evaluate provider quotes against Medicare baselines and existing clinic fee schedules.
• Cross-Functional Collaboration with Care Navigation
  • Serve as the go-to pricing and billing resource for Care Navigators on ad hoc and complex referrals.
  • Troubleshoot live point-of-service billing issues when a clinic front desk is unfamiliar with direct/cash-pay coordination.

Qualifications

• 2–4+ years of experience in healthcare revenue cycle, medical billing/coding, or direct provider contracting.
• Strong working knowledge of CPT, HCPCS, and ICD-10 codes.
• Hands-on familiarity with Cash-Pay / Self-Pay processes.
• Confident Phone & Written Negotiator.
• High Operational Urgency & Organization.

Requirements

• Ability to read a clinical order and identify which CPT codes apply.
• Understanding of global surgical periods and common modifiers.
• Experience requesting or building self-pay estimates and executing point-of-service payments.

Preferred Qualifications

• Active coding or revenue cycle certification (CPC, CPB, CCS-P, CRCR, or equivalent).
• Experience in Direct Primary Care (DPC) or Direct Contracting.
• Background in multi-specialty outpatient settings.
• Bilingual (English/Spanish) is a plus.