Open to opportunities

Courtney Conde

@courtneyconde

Senior CPhT specializing in remote PBM and specialty (IVIG) claims operations, reimbursement optimization, and prior authorization appeals.

United States

Message

What I'm looking for

I’m looking for remote PBM operations and specialty billing work where I can drive claims resolution, prior authorizations/appeals, and reimbursement strategy—using root-cause analysis and cross-functional collaboration to improve speed, accuracy, and margin.

I’m a CPhT with over 9 years of pharmacy experience across PBM claims adjudication, specialty (IVIG) billing, mail-order operations, and retail pharmacy workflows. I’m known for processing 100+ claims daily while protecting margin through sourcing analysis and reimbursement optimization.

In my most recent specialty IVIG role, I managed end-to-end workflows for 35–45 patients weekly, including intake, order entry, packing, and delivery coordination. I submitted and tracked billing through major medical and PBM channels, owned prior authorization tracking, and managed appeals to improve turnaround for patient therapy starts.

I also strengthen operations by troubleshooting denials using root-cause analysis, then collaborating with prescribers, payers, pharmacists, logistics teams, and patients to resolve coverage issues efficiently. Whether it’s PBM systems or high-volume mail order processing, I bring a compliance-first mindset, including HIPAA adherence and controlled substance management.

Experience

Work history, roles, and key accomplishments

Specialty IVIG Pharmacy Tech

Paragon Healthcare Inc

Sep 2024 - Apr 2025 (7 months)

Managed end-to-end workflow for 35–45 IVIG patients weekly, including intake, order entry, packing, and delivery coordination. Submitted and tracked billing across major medical and PBM channels, owned prior authorization/appeals for denied claims, and analyzed IVIG claim profitability to improve reimbursement strategy.

IVIG Billing Prior Authorizations Medical Reimbursement Profitability Analysis Workflow Management Cross functional Coordination

Pharmacy Data Specialist

StarCare Pharmacy

Sep 2022 - Aug 2024 (1 year 11 months)

Processed and verified 100+ prescription claims daily in a high-volume, deadline-driven environment while protecting profitability. Adjudicated PBM claims, resolved coverage issues with providers and insurers, and identified sourcing/reimbursement trends to support margin improvement.

Reimbursement Analysis Sourcing Optimization Pharmacy Margin Protection

Mail Order Pharmacy Technician

Humana

Dec 2019 - Nov 2021 (1 year 11 months)

Adjudicated 38–40 rejected claims per day by investigating root causes and applying corrective actions to secure reimbursement. Partnered with prescribers, patients, and insurers to resolve denials and ensure timely, compliant PBM mail-order processing.

PBM Rejection Resolution Root Cause Analysis Denial Management Claims Adjudication High Volume Data Entry

Inventory Specialist

CVS Pharmacy

Aug 2016 - Jun 2020 (3 years 10 months)

Managed inventory for a high-volume retail pharmacy, maintaining medication availability while minimizing waste and expired product. Completed controlled substance reconciliation and regulatory documentation in compliance with DEA and state requirements, and processed/verified prescription orders with consistent accuracy.

Inventory Management Regulatory Documentation