Wendy L. Souza

**** ******* *****

Gloucester Point, VA 23062

804-***-****

Employment History:

Magellan Rx, 11013 W. Broad Street, Glen Allen, VA 23060

From: Sept 1996 to Present

Current Position: Claims Auditor (from Feb 16-present)

Duties: The auditing of incoming POS (point-of-sale) claims from various nationwide pharmacies for billing accuracies. Reporting discrepancies. Speaking with pharmacists and corporate offices to resolve billing disputes. Creation of reports for monthly reporting to supervisor following multi-state contractual guidelines.

From Nov 2014-Feb 2016

Certified Pharmacy Technician

Duties: working in an incoming call-based call center fielding calls from pharmacies nationwide with questions on billing, obtaining prior authorizations for medications. Reviewing clinical documentation and entering overrides into our system for PA’s to be approved. Escalating serious or very detailed clinical prior authorizations to Pharmacists for final approval.

From July 2013-Nov 2014

Clinical Claims Processor

Duties: working primarily with our Tennessee Medicaid account entering their patient claims into our system for billing purposes. Handled returned mail to include logging the names and addresses of members into a monthly report filed to TennCare. Researching of unpaid claims to find resolution for the claims to ultimately be paid or denied.

Xerox

620 Moorefield Park Dr, North Chesterfield, VA 23236

From: June 2010-July 2013

Claims Team Leader/Customer Call Center Representative

Duties: Managed a group of 6 colleagues in the daily processing of VA Medicaid medical claims, handled incoming calls from providers on various claim questions from billing and coding to ICD9 codes.

Education:

CPhT- National Certification as a Pharmacy Technician since December 2014.

University of Phoenix- Graduated November 2011 with AA in Healthcare Administration.

Long Beach Community College September 1986-September 1987

Classes in Accounting and Business Law.

Skills:

Keyboarding- 55 wpm

10-key 11,000 sph

Working Knowledge of Microsoft Office

Cashiering-Money Handling, Cash Reconciliation