Medical Billing Specialist

Hightop Health is seeking a Medical Billing Specialist that supports the financial integrity of the practice by accurately processing, submitting, and following up on claims for professional services. They ensure that billing activities are performed in compliance with payer requirements, Hightop Health policies, and applicable regulations, and that documentation supports the services billed. This position helps Hightop Health maintain accurate patient accounts, support revenue cycle performance, and comply with accreditation expectations related to qualifications, competency, documentation, and patient rights, including those of The Joint Commission as applicable.

Primary Objectives and Essential Duties:

Medical Billing Specialist focus on timely, accurate, and compliant billing and collections processes that support high-quality patient care and a positive patient financial experience. All duties must be performed in a way that protects patient privacy, promotes accuracy, and adheres to Hightop Health policies and procedures. Specific duties include the following:

• Review encounter documentation, charge tickets, and electronic health record (EHR) data to ensure appropriate coding and charge capture for services rendered, in coordination with clinical staff and coders as applicable.

• Accurately enter, edit, and verify charges in the practice management/EHR system following Hightop Health billing standards and payer-specific rules.

• Prepare, submit, and track claims to government, commercial, and other payers in a timely manner, ensuring compliance with billing regulations, payer guidelines, and Hightop Health policies.

• Work claim rejections, denials, and payment variances by researching root causes, correcting errors, appealing when appropriate, and coordinating with clinical and administrative staff to obtain needed documentation or clarifications.

• Monitor outstanding accounts receivable and follow up on unpaid or underpaid claims in accordance with Hightop Health timeliness and productivity expectations.

• Post payments, adjustments, and denials accurately; reconcile daily batches as assigned, and identify trends in denials or payment issues for escalation or process improvement.

• Patients with delinquent balances will be transferred to our in-house collections with continued follow-up.

• Support patient financial experience by:

  • Assisting with patient billing inquiries within scope and training

  • Explaining statements or balances professionally and respectfully

  • Escalating complex issues to leadership or designated staff per Hightop Health policy

• Protect patient privacy and confidentiality by adhering to HIPAA and Hightop Health privacy/security policies in all written, verbal, and electronic communications.

• Participate in performance improvement and revenue cycle optimization initiatives, including identification of recurring billing errors, documentation gaps, or process inefficiencies and assisting with corrective actions.

• Maintain up-to-date knowledge of payer policies, coding/billing changes, and Hightop Health billing procedures; participate in required training, in-services, and staff meetings.

• Promptly report suspected compliance issues, safety concerns, or ethical concerns through Hightop Health’s designated channels.

• Collaborate with front-office, clinical, and management staff to support accurate registration, insurance verification, authorization, and documentation processes that impact billing.

Note: Hightop Health reserves the right to change or assign other duties to this position

Competencies:

• Knowledge of basic medical billing and coding concepts

• Understanding of payer claim submission requirements, basic reimbursement methodologies, and common denial reasons, with the ability to follow established workflows to resolve issues.

• Ability to understand and apply Hightop Health policies and procedures, as well as applicable laws and regulations, including HIPAA and relevant billing/compliance standards.

• Strong attention to detail and accuracy in data entry, charge review, and payment posting.

• Effective written and verbal communication skills, including the ability to communicate respectfully and clearly with patients, staff, payers, and other stakeholders.

• Ability to use basic operational and financial data (e.g., work queues, reports, denial trends) to guide daily work and support performance improvement efforts.

• Demonstrated commitment to patient rights, including respectful communication, privacy protection, and professionalism when discussing financial matters.

• Ability to organize and prioritize tasks, manage time effectively, and work both independently and as part of a team in a fast-paced environment.

Education/Licensure:

• High school diploma or equivalent required.

• Additional education in health information management, medical billing/coding, healthcare administration, or a related field preferred.

• Certification in medical billing or coding (e.g., through AAPC, AHIMA, or similar) preferred but not required, depending on Hightop Health policy.

• Completion of Hightop Health-required billing, compliance, and privacy training within established timeframes.

Skills and Work Experience Requirements:

• 3 – 5 years of experience in medical billing, coding, or healthcare revenue cycle required; experience in a medical office or outpatient setting is beneficial.

• Proficiency with practice management systems, EHRs, and standard office software (e.g., word processing, spreadsheets, email).

• Working knowledge of insurance verification, prior authorization processes, and patient eligibility concepts is preferred.

• Familiarity with HIPAA privacy and security requirements and the ability to maintain confidentiality of sensitive information.

• Demonstrated ability to problem-solve billing issues, follow established workflows, and seek assistance appropriately when issues fall outside of training or authority.

About Hightop Health

Hightop Health is the premier outpatient mental health group, committed to setting the standard for superior patient care. Our Centers of Excellence combine cutting-edge research, advanced treatment options, and industry-leading expertise to deliver evidence-based, integrative psychiatry that treats the whole person. Care is provided by top-tier clinicians who truly care, and each treatment plan is as unique as the patient receiving it, blending traditional and novel interventions, biological and psychological approaches, and personalized strategies informed by real-world outcomes.

We are a clinician-centric practice, supported by an interdisciplinary team and robust infrastructure, allowing providers to focus on delivering the highest quality care while we manage operational and administrative details.