Candice Batista
Orlando
Summary
Dynamic professional with over 10 years of management experience in the pharmaceutical and insurance sectors. Proven expertise in analytical problem-solving, billing, accounting, and customer care. Committed to driving organizational success through effective training and leadership. Seeking opportunities for professional growth and advancement.
Overview
26
26
years of professional experience
Work History
Pharmacy Resolution Specialist
Centene Corporation
Sebring
04.2023 - 12.2025
- Facilitated prior authorization overrides and formulary inquiries for patients and medical staff, ensuring compliance with Medicaid guidelines and expediting patient access to medications.
- Collaborated with clinical pharmacists, claims team, providers, and internal departments to resolve escalated issues, enhancing patient care and service efficiency.
- Supported first-call resolution by leveraging pharmacy benefit system resources and Medicaid policies for member service.
- Resolved complex issues through teamwork and effective communication, improving interdepartmental collaboration and patient outcomes.
Compliance Analyst
Wright National Flood Insurance Services LLC
St. Petersburg
11.2018 - 04.2023
- Conducted research, data collection, testing, and analysis to identify trends that justified project initiatives.
- Monitored and prepared biweekly quality assurance reports on agents' performance trends to inform management decisions.
- Managed project scope, schedule, and goals in alignment with business objectives.
- Developed progress reports, proposals, and documentation for stakeholders, enhancing project communication.
- Facilitated projects by participating in teams and managing confidential responsibilities.
- Documented process changes, enhancements, and modifications effectively.
- Assisted in developing training materials and supporting new processes.
- Maintained professional communication with leadership, team members, IT, and departments.
Flood Specialist I
Wright National Flood & SkyBridge Resources Temp to Hire
08.2018 - 02.2019
- Underwrote flood policies and followed up with agents and surveyors to verify accuracy and expedite processing.
- Handled inbound/outbound calls with agents, lenders, and insureds regarding underwriting, payments, and FEMA NFIP rules to ensure clarity and compliance.
- Processed zone determinations, entered data, and distributed declarations pages to facilitate timely communication.
Patient Support Services
WellDyneRX/HillCour, Inc.
Lakeland
02.2014 - 08.2018
- Managed outbound calls to health care providers for Spiriva program promotion, confirmed patient orders, issued refill reminders, coordinated return packages, and followed up on investigations; handled inbound calls from patients and providers regarding order status, enrollment, and first call resolutions.
- Conducted Brilinta adherence follow-up calls, arranged post-discharge calls, investigated insurance claims, and managed prior authorizations to facilitate patient access to medication.
- Spiriva Queue back-up confirming receipt of initial orders and Spiriva doctor outbound promotion calls
- Conducted outbound calls to health care providers to verify and update their contact information.
- Audit Member Services phone calls -Quality Assurance
Adjudication and Contracting Specialist
WellDyneRX/HillCour, Inc.
Lakeland
02.2014 - 08.2018
- Enter new enrollments for Brilinta, setup post-discharge, and adherence calls, run test claims and investigate insurance benefits, make adherence calls out to patients, monitor Member Services patient follow-up activity, and send out communications to physicians and patients
- Request insurance contract and work on re-credentialing for Eagle Pharmacy
- Request, submit and maintain pharmacy insurance contracts
- Created and maintained bi-weekly Member Services enrollment bonus spreadsheet to track and request bonus payments from AR
- Maintain two weekly reports for AstraZeneca and Boehringer-Ingelheim
- Created two weekly trending reports while maintaining three trending reports
- Daily monitoring of Member Service Outbound Call Queue overdue calls and
- Conducted quality assurance audits on Member Services phone calls to ensure compliance and enhance service quality
- Developed three guides for Business Advancement and one for Member Services to streamline processes and improve team efficiency
Pharmacy Customer Support Specialist
Publix Supermarket, Pharmacy Operations
Lakeland
01.2007 - 03.2014
- One call resolution for Pharmacy Part B claims and, at times, assisted with billing BCBS of Florida Advantage claims
- Accessing the PECOS system to confirm a physician is enrolled
- Created and maintained policy and procedure guides, prescription templates for storewide use, and various documents to streamline operations
- Reviewed audits and processed denials for part B items
- Collaborated with A/R to evaluate claim status and identify options for write-offs or reimbursement processes
- Obtained access to insurance websites as well as setting up access for co-workers and select A/R members to confirm, review benefits and check for payments
- Accessed NHIN to confirm payment or non-payment of a claim to grant or deny a refund of less than $200 at the store level
- Facilitated training sessions for representatives and pharmacy students to enhance team knowledge and operational efficiency
Pharmacy Biller
Children's Home Pharmacy Services
Orlando
06.2006 - 12.2006
- Medicaid Billing and paper billing of compound drugs
- Managed accounts receivable by tracking outstanding invoices and processing payments to ensure timely revenue collection
- Posted payments and organized office documents to maintain efficient record-keeping, while sending and following up on patient statements
- Sent out patient statements
- Inbound and outbound calling to patients' parents and insurance companies
- Developed three policy and procedure guides to streamline operational processes
Refill Coordinator
Aetna Specialty Pharmacy
Orlando
10.2005 - 05.2006
- Processed 20-40 prescription refills daily, ensuring timely access to medications for patients
- Coordinated deliveries with patients and physicians, facilitating smooth and timely receipt of medications
- Resolved prescription rejections by effectively communicating with pharmacies and patients to secure necessary overrides
- Inbound and outbound compliance calls to patients for refills between 80-100 per day
Managed Care Coordinator
CuraScript, Inc.
Orlando
07.2002 - 10.2005
- Secured re-authorizations and retro-authorizations for patient medications, ensuring timely access to necessary treatments.
- Managed inbound and outbound calls regarding compliance and insurance issues, supporting pharmacists, doctors, and patients effectively.
- Point of contact for GHI, Bristol Park, and Brown and Toland patients
- Point of contact for Senispar patients and attended weekly conference meetings with the manufacturer
- Developed two procedure manuals for scheduling first orders and the reauthorization department, standardizing processes and improving operational clarity.
- Cross-trained employees across six departments and assisted pharmacists with claim rejections and overrides.
- Compiled and analyzed aging reports to identify outstanding billing issues.
- Resolved customer inquiries on initial contact to enhance service efficiency.
Customer Service Representative
United Health Care
Lake Mary
09.2001 - 06.2002
- Inbound customer service for group billing and enrollments of small groups 80 calls per day
- Answered inquiries regarding enrollment, invoices, reconciliations, reinstatements, auto drafts (ACH), preexisting conditions, and payments to ensure customer understanding and satisfaction
- Processed terminations, issued ID cards, and completed enrollment forms to maintain accurate records and support customer transitions
- Assisted Mini-Cobra team with processing terminations to ensure compliance and timely updates for affected customers
Night Shift Customer Service Supervisor
Workable Solutions
Orlando
05.2000 - 09.2001
- Inbound and outbound customer service for Health Pass (collection of insurance providers in the state of New York: HIP, GHI, Horizon, and PHS), Caroliance, AOI, AWB, CHPA, WSI, and Pointless Driving School
- Performed data entry, quoted insurance options, sent weekly reports, and followed up with employers, employees, agents, and health carriers to ensure accurate communication and information flow
- Coordinated scheduling of driving classes for students at BDI, TCAC, and START driving schools to optimize class attendance and availability
- Trained ten employees on client-specific processes and developed two training manuals to standardize onboarding and improve training efficiency
Education
Bachelor of Science - Business Administration, Health Care
Herzing University
Orlando, FL04-2009
Skills
- Prior authorization management
- Pharmacy benefit systems
- Regulatory compliance practices
- Quality assurance processes
- Data analysis techniques
- Process improvement initiatives
- Project management principles
- Customer relationship management
- Patient advocacy methods
- Negotiation techniques training
- Attention to detail
- Multitasking capabilities
- Team collaboration
- Problem solving strategies
- Effective communication skills
Timeline
Pharmacy Resolution Specialist
Centene Corporation
04.2023 - 12.2025
Compliance Analyst
Wright National Flood Insurance Services LLC
11.2018 - 04.2023
Flood Specialist I
Wright National Flood & SkyBridge Resources Temp to Hire
08.2018 - 02.2019
Patient Support Services
WellDyneRX/HillCour, Inc.
02.2014 - 08.2018
Adjudication and Contracting Specialist
WellDyneRX/HillCour, Inc.
02.2014 - 08.2018
Pharmacy Customer Support Specialist
Publix Supermarket, Pharmacy Operations
01.2007 - 03.2014
Pharmacy Biller
Children's Home Pharmacy Services
06.2006 - 12.2006
Refill Coordinator
Aetna Specialty Pharmacy
10.2005 - 05.2006
Managed Care Coordinator
CuraScript, Inc.
07.2002 - 10.2005
Customer Service Representative
United Health Care
09.2001 - 06.2002
Night Shift Customer Service Supervisor
Workable Solutions
05.2000 - 09.2001
Bachelor of Science - Business Administration, Health Care
Herzing University