Candice Oakes
Pittsburgh,PA
Summary
Detail-oriented and customer-focused professional seeking a Pharmacy Benefits Verification position where I can utilize my knowledge of insurance verification, prior authorizations, and pharmacy benefit processes to ensure accurate coverage determination and support positive patient outcomes.
Overview
13
13
years of professional experience
Work History
Inventory Specialist
Evernorth
Warrendale, Pennsylvania
05.2026 - Current
- Managed Accredo specialty pharmacy inventory records and daily stock reconciliation.
- Tracked specialty medication receipts, transfers, and storage locations.
- Reviewed inventory data in ERP systems for accuracy.
- Communicated inventory needs with pharmacists and distribution staff.
- Performed scheduled inventory counts and supply audits.
- Prepared order documentation for warehouse and pharmacy fulfillment.
- Participated in physical inventory counts to keep information accurate and current.
- Performed inventory cycle counting and identified discrepancies.
- Investigated discrepancies between physical count and computer records.
- Ensured proper storage conditions for all items in the warehouse.
- Responded promptly to requests from customers regarding product availability.
Administrative Assistant
Tryfacta, Allegheny Public Lab
Warrendale, Pennsylvania
02.2026 - 04.2026
- Managed calendars, meetings, and correspondence for public health lab administration.
- Prepared letters, reports, and forms for Tryfacta and Allegheny Public Lab staff.
- Answered phones and directed inquiries to proper laboratory and office contacts.
- Filed confidential records and maintained organized administrative document systems.
- Tracked incoming mail, supplies, and office requests for daily operations.
- Entered data into office databases and updated administrative records accurately.
- Supported supervisors with clerical tasks and general office assistance.
Inventory specialist
Insight Global
Pittsburgh, Pennsylvania
06.2025 - 09.2025
- Proficient in inventory management software
- Strong attention to detail
- Excellent organizational skills
- Ability to work in a fast-paced environment
- Knowledge of supply chain management principles
- Strong communication skills
- Ability to analyze data and identify trends
- Experience with cycle counting and inventory reconciliation
- Ability to prioritize and multitask effectively
- Knowledge of inventory control best practices
Labrotory Operator
Emerald Cloud Labrotory
03.2024 - 06.2025
- Ability to work safely in a laboratory environment. Chemical Handling, PPE, Trained in safety equipment.
- Ability to work safely with general laboratory equipment (Heat blocks, incubators, Cryostores, instruments with magnetic fields)
- Experience in use of common laboratory (equipment. (Pipettes, Mico and general balances, centrifuge, vortex, mixers, sample imagers, liquid level detectors)
- Trained in Biosafety Cabinets (Aseptic techniques, Disinfection procedures, Workplace organization)
- Experienced in the operation, maintenance, and qualification of specific laboratory instrumentation (High Performance Liquid Chromatography-HPLC, Liquid Chromatography/ Mass Spectrophotometry- LCMS, Nuclear Magnetic Resonance-NMR, X-Ray Crystallography, Automated Liquid Handlers-Hamilton, Automated Thermal Cyclers
- Proficient in a vary of information systems (Laboratory information Management System- LIMS; ECL Engine, Workplace communication and direct messaging- SLACK, Google Suite
- Demonstrated competence with general laboratory and workspace functions (Inventory management and control of specimens and reagents.
- Shipping and Receiving, Active troubleshooting of system and instrument failures, Accurate maintenance of various records and logs
Mail Room Clerk
SPS/Insight Global
12.2023 - 02.2024
- Separates and delivers mail for delivery to distribution areas within BNY Mellon Downtown.
- Delivers mail to correct departments, and picks up any outgoing mail.
- Sorted outgoing letters and packages according to destination and type.
- Weighs outgoing mail to determine the cost if weight exceeded the normal weight.
- Personally delivers mail or packages to person if signature is required.
Reimbursement Specialist
Caremex
04.2023 - 11.2023
- Experience working in the healthcare industry or accounts receivable field.
- Verifies new and existing patients have necessary referral and/or authorization documentation prior to examination date.
- Verifies patient demographics and insurance providers, updates information in systems, and documents conversations.
- Demonstrate knowledge of state & federal collections guidelines.
- Experience in medical billing, medical insurance verification, managed care and/or patient registration required.
- Demonstrates knowledge of health insurance plans including Medicare, Medicaid and commercial carriers.
- Investigated and verified all insurance claims for Major medical, Medicare, and Medicaid.
- Issued payment or dismissal notices.
- Accurate compliance with local, state and federal regulations and company policies.
- Preparing reports on investigation, settlements, denials of claims, individual evaluation of individual parties, etc.
- Consistent professional behavior and ability to handle confidential information.
- Able to work independently, prioritizing and organizing workload effectively to complete tasks within the timeframes delegated.
- Contact insurance companies to verify primary and secondary insurance coverage for both in-network and/or out of network physical therapy benefit coverage.
Sr. Reimbursement Representative
Insight Global- UBC
12.2022 - 03.2023
- Ensures insurance coverage by telephone.
- Resolves any issues with coverage and escalates complicated issues to management.
- Coordinates with clinical staff to obtain compliance.
- Codes procedures performed and diagnosis on charge.
- Assigns appropriate ICD-9, ICD-10, CPT and HCPCS codes to accurately support the need and documentation for each service.
- Resolves routine patient billing inquiries and problems.
- Verified benefits for Major medical, Specialty Pharmacy, and Pharmacy benefits, as well as followed up on Prior Authorization.
- Worked closely with Medicare, and medicaid patients, and providers.
- Verifies benefits for Major Medical, Specialty Pharmacy, and Retail Pharmacy Benefits.
Case Manager/data entry
ConnectiveRX Endo Advantage, and JazzCares
04.2019 - 11.2022
- Manages the Care Coordination process within an assigned territory while balancing the needs of individual patients and physicians with the business realities and necessities of the program.
- Assesses physicians' needs and develops action plans that provide for the introduction of therapy while coordinating the exchange of all patient-related information with internal and external customers.
- Had an assigned region that I was responsible for, working closely with Field Reimbursement Manager.
- Assists in obtaining insurance approval for therapy, and proactively plans to mitigate delays in coverage by working with the patients and their family, healthcare providers, insurance companies, and specialty pharmacies.
- Exhibits a leadership role within the assigned territory. Able to consistently identify complex patient specific issues and develop action plans accordingly. Demonstrates accountability for action plan execution, and energetically drives for success and results.
- Consistently maintains accurate data on each individual, their insurance, coverage approvals, on-going coverage requirements and all patient and provider interactions. Coordination of information with all customers is required.
- Obtains insurance information necessary for various clinical services or procedures. Also works with Assistance Programs and enroll if eligible. Follow up with Prior Authorization and Appeals.
- Effectively shares reimbursement and other knowledge with patient care team members through orientation training, case studies, consultation for complex cases and special projects as requested.
- Verified benefits for Major medical, Specialty Pharmacy, and Pharmacy benefits, as well as followed up on Prior Authorization.
- Worked closely with Medicare, and medicaid patients, and providers.
- Investigated and verified all insurance claims for Major medical, Medicare, and Medicaid.
- Issued payment or dismissal notices.
- Processing claims and reimbursement for Copay Assistance, and Patient assistance programs.
- Accurate compliance with local, state and federal regulations and company policies.
- Preparing reports on investigation, settlements, denials of claims, individual evaluation of individual parties, etc.
- Quality Assurance training.
- Supervisor training.
Benefit verification representative/Case manager
Lash Group
08.2018 - 04.2019
- Ensured accurate data entry into healthcare verification applications.
- Entered pertinent information in a timely manner while paying special attention to detail.
- Complied with federal regulations, including HIPAA provisions.
- Examined pertinent information to determine the accuracy of client requests and related paperwork.
- Maintained and revised procedural lists, control records and coded schemes to process source data.
- Supported and complied with all company policies, processes and procedures including the Compliance Program and the Code of Conduct.
- Reviewed and resolved discrepancies in received data and performed data verification routines in accordance with company procedures.
- Verified benefits for Major medical, Specialty Pharmacy, and Pharmacy benefits, as well as followed up on Prior Authorization.
- Worked closely with Medicare, and medicaid patients, and providers.
- Assured that all requirements necessary are present per insurance verification.
Customer Care Coordinator
Alliance RX Walgreens Prime Specialty Pharmacy
02.2018 - 08.2018
- Managed order entry workload so that orders were entered the day received.
- Completed specialty medication Refill orders for Patients and Doctor Office's.
- Coordinated orders with production and logistics to ensure on time and complete to customers. Addressed incoming customer inquiries and offered productive solutions that increased customer satisfaction.
- Assisted consumers with questions regarding our product.
- Advocated for customers in improving availability and delivery.
Benefits Verification Coordinator
Kelly Services/ AmerisourceBergen
01.2017 - 02.2018
- Ensured accurate data entry into healthcare verification applications.
- Entered pertinent information in a timely manner while paying special attention to detail.
- Complied with federal regulations, including HIPAA provisions.
- Examined pertinent information to determine the accuracy of client requests and related paperwork.
- Maintained and revised procedural lists, control records and coded schemes to process source data.
- Supported and complied with all company policies, processes and procedures including the Compliance Program and the Code of Conduct.
- Reviewed and resolved discrepancies in received data and performed data verification routines in accordance with company procedures.
- Assured that all requirements necessary are present per insurance verification.
Shift Supervisor
Rite Aid
01.2016 - 01.2017
- Oversee 5-8 employees work in the front end of store to ensure compliance with company policies, regulations, and safety guidelines.
- Supervising employees in their duties and providing advice and customer assistance when required.
- Performing cash management tasks, including counting money in registers and making bank deposits.
- Unloaded the truck every week for stock.
- Ensured that the building was fully secured after night shifts.
Customer Service Representative
Beacon Hill Temp Agency/ Jones Lang Lasalle
01.2015 - 01.2016
- Enter new load information into the system quickly and accurately.
- Calculate transit times and deliver information to customers.
- Build relationships with customers to positively represent the company and encourage return of business.
- Strong Interpersonal communication skills.
- Deep knowledge and practice in banking company.
- Process customer orders by data entry into computer system; verify accuracy prior to customer leaving station.
Waitress
Quaker Steak and Lube
01.2014 - 01.2015
- To understand the customer's needs and expectations to provide quick, accurate service and satisfaction.
- Must memorize the menu and be prepared to answer any questions regarding the menu and or restaurant.
- Occasional hostess to cover a staff shortage. Cordially greeting, welcoming and seating guests.
- Banquet server for private affairs.
- Occasional register coverage if there is a momentary need to keep the customer flow steady and the experience positive.
- Decorations, table set ups, and dessert displays.
- Provide detailed training for new hires.
Education
Carrick High school
Allegheny County01-2008
Skills
- Insurance verification
- Healthcare reimbursement
- Data entry
- Effective communication
- Attention to detail
- Time management
- Claims processing
- Healthcare billing
- HIPAA compliance
- Prior authorization
- Insurance eligibility
- Medicare billing
- Denial resolution
- HCPCS knowledge
- Private insurance policies
- Medical coding
- ICD-10 proficiency
- Appeals handling
Custom
September 2023-November 2023 Caregiver for my mother who was terminally ill.
Timeline
Inventory Specialist
Evernorth
05.2026 - Current
Administrative Assistant
Tryfacta, Allegheny Public Lab
02.2026 - 04.2026
Inventory specialist
Insight Global
06.2025 - 09.2025
Labrotory Operator
Emerald Cloud Labrotory
03.2024 - 06.2025
Mail Room Clerk
SPS/Insight Global
12.2023 - 02.2024
Reimbursement Specialist
Caremex
04.2023 - 11.2023
Sr. Reimbursement Representative
Insight Global- UBC
12.2022 - 03.2023
Case Manager/data entry
ConnectiveRX Endo Advantage, and JazzCares
04.2019 - 11.2022
Benefit verification representative/Case manager
Lash Group
08.2018 - 04.2019
Customer Care Coordinator
Alliance RX Walgreens Prime Specialty Pharmacy
02.2018 - 08.2018
Benefits Verification Coordinator
Kelly Services/ AmerisourceBergen
01.2017 - 02.2018
Shift Supervisor
Rite Aid
01.2016 - 01.2017
Customer Service Representative
Beacon Hill Temp Agency/ Jones Lang Lasalle
01.2015 - 01.2016
Waitress
Quaker Steak and Lube
01.2014 - 01.2015
Carrick High school