YUDELKIS FRIAS
Deltona
Summary
Detail-oriented healthcare professional with over 10 years of experience in healthcare administration, reimbursement compliance, and documentation auditing. Skilled in reviewing case files and operational records for accuracy and compliance with payer, manufacturer, and regulatory standards. Proven ability to improve processes, ensure data integrity, and communicate effectively with healthcare providers, manufacturers, and internal teams to maintain compliance and support quality assurance objectives.
Overview
19
19
years of professional experience
Work History
Field Liaison
UBC
07.2023 - Current
- Review documentation and case records to ensure accuracy and compliance with manufacturer and payer guidelines.
- Analyze and track case data for quarterly business reviews and provide reports identifying compliance gaps and improvement opportunities.
- Serve as liaison for prescriber offices, manufacturer representatives, and health plans to maintain workflow efficiency and regulatory adherence.
- Support program-specific process development (PSPs) to improve documentation and reporting accuracy.
- Train and support team members on documentation and compliance procedures.
Case Manager
UBC
01.2017 - 01.2023
- Managed a high-volume caseload while ensuring all documentation met payer and program compliance standards.
- Coordinated communication between patients, providers, and specialty pharmacies to maintain continuity of care and compliance deadlines.
- Performed benefit verifications, prior authorization reviews, and documentation quality checks.
- Prepared compliance reports summarizing case findings and outcomes.
Reimbursement Specialist
Express Scripts
01.2016 - 01.2017
- Reviewed patient and provider documentation for insurance compliance and authorization accuracy.
- Verified benefits, ensured payer requirements were met, and tracked recertifications for ongoing approvals.
- Collaborated with providers to correct documentation errors and maintain audit readiness.
Senior Clerk
Montefiore Medical Center
01.2012 - 01.2016
- Verified patient eligibility and benefits documentation in accordance with hospital and payer policies.
- Maintained accurate records supporting billing and compliance audits.
Podiatry Assistant
Midtown Podiatry
01.2007 - 01.2012
- Verified insurance benefits, submitted prior authorizations, and supported compliance with payer requirements.
- Maintained accurate billing records and patient documentation for quality and audit purposes.
- Performed patient screenings and assisted in daily clinical operations while adhering to quality standards.
Education
Bachelor's Degree - Health Services Administration
Monroe College
Bronx, NY01.2013
A.A.S. - Hospitality and Tourism Management
Monroe College
Bronx, NY01.2004
Skills
- Regulatory Compliance & Documentation Accuracy
- Pharmaceutical Program Support & Quality Review
- Audit Preparation & Data Verification
- Process Improvement & Case Management
- Stakeholder Communication & Training
- Microsoft Office Suite (Excel, Word, Outlook)
- Analytical & Problem-Solving Skills
- Field operations
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
Senior Clerk
Montefiore Medical Center
01.2012 - 01.2016
Podiatry Assistant
Midtown Podiatry
01.2007 - 01.2012
Bachelor's Degree - Health Services Administration
Monroe College
A.A.S. - Hospitality and Tourism Management
Monroe College
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