Human Resources

DeAudrea C. Wallace

Summary Qualifications

Administrative Support professional experienced in working in fast-paced environment, demonstrates exceptional organizational, technical, and interpersonal skills. Trustworthy, ethical, and discreet committed to superior customer service. Confident and poised in interactions with individuals at all levels: Detail-oriented and resourceful in completing projects with ability to effectively multi-task. Capabilities include:

Customer Service & Relations Benefits Data Entry Problem Solving

Word Processing & Typing Filing & Reconciling Quick learner

Computer Operations Office Equipment Operation Telephone etiquette

Education

Bachelor of Science, Business Management - 11/2007

Human Resource Management Certification - 4/2008

University of Phoenix, Houston, TX

Experience

Universal American Corp Managed Care Division - Heritage Health Systems, Houston, TX 4/2006 - Present

Pharmacy Benefits Administrator

• Provide assistance to members regarding various insurance programs such as medical, dental and vision accounts.

• Participate in the coordination and communication of the annual open enrollment period.

• Distribute summary of benefits and open enrollment materials.

• Processes approximately 10,000 member benefits elections.

• Assist Pharmacy Benefit Manger as a liaison between the members, providers, and retail pharmacies when necessary to resolve escalated claims.

• Provide prompt and comprehensive superior service as it relates to internal and external pharmacy benefits inquiries and department initiatives.

• Monitor refund distribution requests for participating members – check eligibility for requests and status.

• Prepare and deliver pharmacy utilization reports for all pharmacy-related quality of service, and quality of care concerns on a monthly basis, and for complying with all applicable state and federal regulations.

• Develop, maintain and update computer database to prepare reports, logs and general benefits information; use computer to compile and extract data for internal and insurance carrier requested reports.

• Track and resolve approximately 75 Medicare pharmacy complaints per month using Centers of Medicare and Medicaid (CMS) in their Health Plan Management System (HPMS).

• Answers the pharmacy benefits helpline, responding to member benefit questions and resolves a variety of member benefits issues.

UnitedHealth Group - AmeriChoice, Houston, TX 9/2003 – 4/2006

Health Services Specialist

• Assisted in the administration of pharmacy benefits and preferred drug list through prior notification program.

• Received approximately 75 requests per day for prior notification and non-preferred drug list from physician

offices while using defined criteria in system accurately.

• Efficiently documented the basis of requests and entered system authorizations required for approvals.

• Coordinated evaluation of request by clinical pharmacist and medical directors.

• Researched approximately 50 appeals and complaints per week related to prior notification decisions.

• Gathered documentation from previous cases and forwarded required information to pharmacists and medical directors for evaluation.

The Methodist Hospital, Houston, TX 4/1997-2/2003

Pharmacy Technician, Certified Pharmacy Technician

• Assisted pharmacists in processing approximately 150 prescriptions per day.

• Interpreted and entered approximately 45 medication orders into computer per day.

• Controlled medication inventory.

• Delivered medication to nursing units.

• Ordered and restocked medications.

Skills

• Proficient in MS Office Suite (Word, PowerPoint, Excel, Outlook, Access & Visio) • ADP • AS 400 • Type 60 WPM • 300 KPH • Lotus 1-2-3 & Lotus Notes • Ten-Key by Touch • Xerox Machine • Fax Machine & Desktop Faxing

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