Healthcare Pricing & Direct Pay Specialist

Required Qualifications

• 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 the 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, and Single Case Agreements (SCAs).
• Comfort executing point-of-service payments and reconciling itemized superbills/receipts.
• Strong phone and written negotiation skills.
• High operational urgency and strong organization for handling high-volume task queues in an EHR/ticketing system.

Preferred Qualifications

• Active coding or revenue cycle certification such as CPC, CPB, CCS-P, or CRCR, or equivalent hands-on specialty clinic/ASC financial estimation experience.
• Experience in Direct Primary Care, Direct Contracting, Reference-Based Pricing, 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.