Summary
Overview
Work History
Education
Skills
Timeline
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Joseph Rodriguez

Jersey City,NJ

Summary

Bringing 4+ years of experience as a Field Reimbursement Manager with expertise in the NY Metro territory. Successfully launched and supported 9 pharmaceutical products, with 6 being new product introductions. Proven ability to foster and maintain relationships with key accounts in NYC and Northern NJ. Demonstrated commitment to ensuring patient access and affordability, with a goal to help patients secure their treatments affordably and without barriers. Prior experience as a Revenue Cycle Supervisor at a major cancer center in Newark, NJ, deepening understanding of comprehensive reimbursement dynamics. Leveraging a certification in professional coding to bridge the gap between clinical delivery and financial operations, ensuring optimized access and reimbursement.

Overview

11
11
years of professional experience

Work History

Field Reimbursement Manager

Xcenda, LLC
01.2020 - Current
  • Supported launch of 6 therapeutics in Multiple Myeloma, Prostate, Bladder, and Lung cancer disease states
  • Assist oncology practices with billing, coding, reimbursement, and copay/financial support surrounding IV and oral products (Part B, Part D) either in-person or virtually
  • Developed and maintained relationships with key stakeholders within academic institutions and community practices (Northern NJ, NYC, Long Island)
  • Maintained strong knowledge of payer coverage/policies within territory
  • Fluent in Salesforce products
  • Act as liaison between accounts and HUB services (resolve complaints, etc.)
  • Reviewed billing and collections process and determined improvements to streamline workflows.
  • Maintained strong knowledge of medical terminology and procedures.
  • Build and maintain relationships with field partners, and key account contacts
  • Attend standing virtual meetings regarding account strategy
  • Collaborate with field partners to access accounts

Financial Supervisor

Fredrick Cohen Cancer And Blood Disorder Center
08.2019 - 12.2019
  • Direct management of Oncology Revenue Cycle Team; Ensuring team members are performing duties effectively and efficiently. (Claim denial research, correction and submission of appeals.)
  • Direct mediation and resolution of intradepartmental concerns and staff disputes
  • Implementation of polices and procedures to reduce denial rate and increase reimbursement
  • Educate physicians on prior auth requirements and payer guidelines (authorization/reimbursement guidelines). In addition to various payer related issues (i.e. coding changes, appropriate claim submission and other payer polices
  • Discuss claim denials with CFO and additional senior management during weekly denial meetings
  • Review outpatient records and interpreted documentation to identify all appropriate ICD-10 and procedure codes (CPT, HCPCS)
  • Apply official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes
  • Enter charges into EMR system efficiently and without errors
    Compiled financial reports pertaining to cash receipts, profit and loss
  • Answer patient questions directly regarding billing, scheduling and treatment. Assisting physician's and their patients in obtaining J-CODE specific benefit information, patient assistance program enrollment, etc
  • Collect and arrange financial information and enter details into financial management system. Including CPT codes for various oncology/hematology medications with appropriate modifiers
  • Obtain prior authorization through Medicare, Medicaid and private payers for testing and procedures including Chemotherapy, Iron Infusions, Blood Transfusions, Etc

Financial Coordinator

Fredrick Cohen Cancer And Blood Disorder Center
09.2017 - 09.2019
  • Answered questions over phone and in-person regarding billing, scheduling and treatment.
  • Contacted insurance carriers to discuss policies and individual patient benefits.
  • Explained insurance benefits, fees and procedures to patients.
  • Submitted claims to insurance companies on same day as patient treatment.
  • Apply official coding conventions and rules from American Medical Association and Centers for Medicare and Medicaid Services to assign diagnostic codes
  • Enter charges into EMR system efficiently and without errors Compiled financial reports pertaining to cash receipts, profit and loss
  • Answer patient questions directly regarding billing, scheduling and treatment. Assisting physician's and their patients in obtaining J-CODE specific benefit information, patient assistance program enrollment, etc
  • Collect and arrange financial information and enter details into financial management system. Including CPT codes for various oncology/hematology medications with appropriate modifiers
  • Obtain prior authorization through Medicare, Medicaid and private payers for testing and procedures including Chemotherapy, Iron Infusions, Blood Transfusions, Etc

Office Supervisor

Medemerge
06.2013 - 08.2017
  • Responsible for direct supervision of front desk staff.
  • Responsible for overseeing cash flow and ensuring all monies (copays, patient balances, testing fees, etc.) are accounted for and properly posted to patient accounts.
  • Promoted accuracy and efficiency in front desk policies and procedures
  • Participated in the development and improvement of clinic and front desk procedures.
  • Maintained an environment conducive to patient comfort and confidentiality.
  • Responsible for direct supervision of front desk staff, ensuring staff perform duties effectively and efficiently
  • Troubleshooted various payer related issues ranging from eligibility to denial appeals

Referral / Prior Authorization Specialist

Medemerge
06.2012 - 06.2013
  • Obtained medical prior authorization for all office procedures, treatments, and special testing ordered (infusion, radiology, lab, etc.)
  • Educated physicians on prior auth requirements and payer guidelines (authorization/reimbursement guidelines)
  • Medical Billing (claim submission, appeal, and payment posting)
  • Generated patient referrals (paper and electronic)
  • Handled incoming calls and respond to queries in a warm and
    professional manner.
  • Greeted patients and scheduled appointments.
  • Organized and maintained medical forms and office stationary
    required for front desk activities.
  • Set up new patient accounts

Education

CPC Certification - Medical Billing And Coding

Medical Coding For Profesionals, LLC
500 North Wood Avenue, Linden, NJ

High School Diploma -

Dunellen High School
Dunellen, NJ
2011

Skills

  • Comprehensive Knowledge of HCPCS, ICD 10, and CPT coding polices and procedures as produced by the AMA and CMS
  • AAPC certified CPC
  • 6 Years Medical Billing Experience (Coding, Charge Capture, Claim Submission, Denial's and Appeal's)
  • 6 Years Medicare, Medicaid, and Private Insurance Prior Authorization Experience (J- Codes, Radiology, Surgical Procedures, etc)
  • 6 Years Benefit Verification and insurance eligibility experience
  • Extensive Knowledge of various drug specific patient assistance programs and enrollment
  • Comprehensive Knowledge of various Online Payer Prior Authorizations Tools and Portals
  • Strong Understanding of Medical Terminology
  • Excellent Telecommunication Skills
  • Microsoft Office Proficient
  • Overall Technologically Savvy

Timeline

Field Reimbursement Manager

Xcenda, LLC
01.2020 - Current

Financial Supervisor

Fredrick Cohen Cancer And Blood Disorder Center
08.2019 - 12.2019

Financial Coordinator

Fredrick Cohen Cancer And Blood Disorder Center
09.2017 - 09.2019

Office Supervisor

Medemerge
06.2013 - 08.2017

Referral / Prior Authorization Specialist

Medemerge
06.2012 - 06.2013

CPC Certification - Medical Billing And Coding

Medical Coding For Profesionals, LLC

High School Diploma -

Dunellen High School

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