Healthcare Pricing Specialist

Job Summary

Detail-oriented and proactive, the remote Healthcare Pricing Specialist will manage CPT code verification, negotiate upfront cash pricing with providers, and collaborate with Care Navigators to ensure seamless direct pay processes for specialist care and procedures.

Key Responsibilities

• Translate clinical orders into accurate CPT codes and verify cash-pay eligibility for services
• Negotiate all-inclusive rates and Single Case Agreements with healthcare providers to secure fair pricing
• Serve as a pricing resource for Care Navigators, addressing billing issues and ensuring a frictionless patient experience

Required Qualifications

• 2-4+ years of experience in healthcare revenue cycle, medical billing/coding, or related fields
• Strong knowledge of CPT, HCPCS, and ICD-10 codes, with the ability to read clinical orders accurately
• Experience with cash-pay processes, including self-pay estimates and point-of-service payments
• Proven negotiation skills with a track record of securing favorable rates from providers
• High operational urgency and organizational skills to manage multiple tasks efficiently