Yudelkis Frias
Deltona,FL
Summary
Highly experienced Field Liaison and healthcare professional with over 8 years of expertise in healthcare administration, specializing in reimbursement processes, case management, and patient advocacy. Proven success in developing and implementing program-specific workflows (PSP) that streamline reimbursement activities and ensure regulatory compliance. Adept at serving as a subject matter expert (SME) for healthcare providers, patients, and manufacturers, optimizing therapy utilization and improving patient outcomes. Skilled in interpreting complex reimbursement policies, resolving intricate dispensing issues, and providing educational resources to healthcare teams.
Overview
9
9
years of professional experience
Work History
Field Liaison
UBC
Lake Mary
07.2023 - Current
- Analyze, track, and present case trend data for Quarterly Business Reviews and deliver high-impact, ad-hoc reports as required by manufacturers and leadership
- Collaborate with manufacturer field teams in implementation of program launch and ongoing therapy utilization through education and training materials that aid in processing referrals
- Act as SME on intricate cases to assigned prescriber offices, manufacturer representatives, health plans, and patients to ensure adequate measures are in place to avoid disruption in drug therapy and identify affordability options for patients
- Provide Program Specific Processes (PSP) support and other special projects to enhance program workflows, reimbursement activities, and on-going utilization.
Case Manager
UBC
Lake Mary
01.2017 - 01.2023
- Managed and resolved complex cases while efficiently coordinating a high-volume caseload
- Served as the main liaison for prior authorization and appeals, effectively communicating with patients, healthcare providers, field reimbursement reps, Specialty Pharmacies, and other stakeholders
- Conducted timely and accurate outreach calls to inform patients, providers, and Specialty Pharmacies about benefits and responsibilities
- Researched alternative funding such as financial and copay assistance programs.
Reimbursement Specialist
Express Scripts
Lake Mary
01.2016 - 01.2017
- Outreached calls to patients and providers regarding benefits and responsibility in a timely manner and accurately
- Conducted benefit investigations, verified insurance benefits for patients and physicians' office, and submitted and obtained prior authorization as required by payer
- Obtained recertification for cases requiring extended treatment/coverage beyond the expiration of original approval.
Education
Bachelor's Degree - Health Services Administration
Monroe College
01.2013
A.A.S - Hospitality and Tourism Management
Monroe College
01.2004
Skills
- Effective Case Resolution Strategies
- Trend Analysis Expertise
- Process Improvement
- Expertise in Client Engagement Strategies
- Microsoft Office Applications Expertise
- Strategic Account Management and Client Relations
- Documentation Management
- Patient Assessment
Languages
Spanish
Native/ Bilingual
Timeline
Field Liaison
UBC
07.2023 - Current
Case Manager
UBC
01.2017 - 01.2023
Reimbursement Specialist
Express Scripts
01.2016 - 01.2017
Bachelor's Degree - Health Services Administration
Monroe College
A.A.S - Hospitality and Tourism Management
Monroe College
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