Appointment Rules Verification Specialist

This a Philippine-based position;

NOT a US based position and the pay rate is not in US currency.

ABOUT FREEDOM HEALTH SYSTEMS, INC:

Freedom Health Systems, Inc. is a mission-driven healthcare advisory and management consulting firm that partners with behavioral health and human services organizations to improve access, equity, and operational excellence. We specialize in guiding providers through program development, accreditation, compliance, and clinical best practices—empowering them to deliver high-quality, person-centered care to their communities.

While we do not provide direct healthcare services, Freedom Health Systems plays a vital role behind the scenes by strengthening organizational infrastructure, supporting service expansion, and helping our partners lead with innovation and integrity. Our expertise spans a wide range of operational services, including revenue cycle management, prior authorization, virtual front office support, medical billing and coding, human resources, and compliance consulting.

At Freedom Health Systems, we are deeply committed to breaking down barriers in the behavioral health space, with a particular focus on serving marginalized and underserved populations. Our team fosters a collaborative, forward-thinking work environment where every employee contributes to advancing impactful, community-based care.

DISCLOSURES:

The specific statements shown in each section of this job description are not intended to be all-inclusive. They represent typical elements and criteria considered necessary to perform the job successfully. The job’s responsibilities/tasks may be modified and/or expanded over time. Company will inform the personnel member when changes in the respective job description are made.

COMPANY WEBSITE:

COMPANY PHONE NUMBER:

HUMAN RESOURCES DEPARTMENT PHONE NUMBER: EXT 10

HUMAN RESOURCES DEPARTMENT EMAIL ADDRESS:

POSITION TITLE : Appointment Rules Verification Specialist

ALTERNATE TITLE(S) : Scheduling Compliance Coordinator, Intake & Verification Analyst

COMPANY : Freedom Health Systems, Inc. (in support of all customer companies under contract)

DIVISION : Operations

DEPARTMENT : Scheduling

UNIT : n/a

BENEFITS PACKAGE : Ineligible.

WORK SCHEDULE : Monday – Friday, 8:00 AM EST – 5:00 PM EST

ACCOUNTABLE TO : Scheduling Department Supervisor (Chief Operations Officer in the absence of the Scheduling Department Supervisor)

ACCOUNTABLE FOR : Verifying that all scheduled appointments are valid, authorized, and compliant with payer rules, internal policies, and state regulations

CLASSIFICATION : W8BEN

COMPENSATION RANGE : ₱283.63 PHP per hour (this is not USD)

ANTICIPATED TRAVEL : none

SUMMARY OF POSITION RESPONSIBILITIES:

The Appointment Rules Verification Specialist is responsible for ensuring the accuracy and compliance of scheduled appointments to prevent billing issues and conflicts. This role involves meticulous oversight of appointment codes, schedule adjustments, and the maintenance of critical scheduling documents. The specialist will coordinate and verify that appointments do not overlap or conflict with other provider appointments, thereby supporting the seamless delivery of services to clients.

SCHEDULED DUTIES AND RESPONSIBILITIES:

• Review scheduled appointments daily and weekly to ensure there are no conflicts with other providers’ appointments
• Adjust and substitute conflicting appointments with valid alternative codes, ensuring providers can continue delivering services without interruptions
• Plan and schedule necessary bloodwork and urine screening appointments for clients, ensuring all relevant appointments are accounted for and non-conflicting
• Export and update the Active Client List in the designated spreadsheet daily, ensuring all entries are current and accurate
• Update the housing roster by comparing Buildium vs. ICANotes Active Clients, specifically updating the "CAT A | CAT B" tab on a weekly basis
• Generate and distribute weekly and monthly reports related to appointment code conflicts, providing detailed analysis and actionable insights to management
• Conduct daily and weekly rules verification to ensure all appointments adhere to established guidelines, reducing the risk of billing concerns and service disruptions
• Update and monitor the DSP and CPRS sheets, comparing the FHS sheet versus the Position Seat Sheet to ensure accurate client assignments
• Maintain and update the DSP/CPRS assignment sheet, ensuring new clients are added and discharged clients are removed promptly
• Monitor and update the DSP/CPRS calendar, ensuring it accurately reflects current assignments and service needs
• Update the PRP calendar for group appointments on a weekly basis, ensuring all scheduled sessions are correctly documented
• Perform other duties as assigned by the Scheduling Department Manager to support the overall efficiency and compliance of the scheduling department
  

UNSCHEDULED DUTIES AND RESPONSIBILITIES:

• Assist your supervisor with any work-related tasks as requested, taking initiative where possible
• Remain informed and compliant with regulations and standards, including COMAR, CARF, and other relevant governing bodies, as well as company policies and procedures
• Support the maintenance of a safe work environment by participating in drills and safety trainings as requested
• Maintain confidentiality of all records, especially those relating to client treatment or financial information
• Participate in external and internal audits/surveys (CARF/CSA/OHCQ) as directed by the supervisor
• Contribute to quality improvement initiatives related to authorization turnaround times or documentation standards
• Cross-reference scheduled appointments with insurance authorizations, referral requirements, and service limits
• Confirm that appointments are scheduled within allowed timeframes, visit caps, and client eligibility parameters
• Flag and resolve scheduling errors prior to the date of service to avoid claim denials or service disruptions
• Communicate directly with scheduling staff, intake teams, and clinical providers to correct or validate appointment entries
• Track trends in scheduling errors and contribute to quality assurance reporting
• Ensure all services are scheduled in accordance with Medicaid, Medicare, and private insurance policies
• Maintain real-time dashboards or logs that reflect the compliance status of upcoming appointments
• Support training efforts for new staff on appointment rules and scheduling compliance procedures
  

PHYSICAL DEMANDS:

• Prolonged periods sitting at a desk and working on a computer
• Frequent meetings via video or phone; occasional in-person site visits

WORKING CONDITIONS:

• Remote
• Fast-paced, deadline-driven environment with collaborative teams
  

COMPETENCIES AND SKILLS:

• Deep understanding of behavioral health and/or medical appointment requirements
• Familiarity with Medicaid/Medicare and private insurance scheduling rules
• Strong attention to detail, time management, and accuracy
• Excellent communication and teamwork skills
• Proficiency with electronic health records (EHRs), scheduling software, and Excel
  

LEVEL OF EDUCATION / TRAINING / QUALIFICATIONS:

• High school diploma or GED required; Associate’s or Bachelor’s degree preferred
• Minimum 1–2 years of experience in healthcare scheduling, billing, or administrative support
• Experience with behavioral health or outpatient medical practices strongly preferred
• Must pass background check and reference screening
• Knowledge of HIPAA and patient confidentiality standards required