Pharmacist

Sylvia B. Couvertier

************@*****.*** • Budd Lake, NJ 07828 • 908-***-****

Pharmacist/Pharmacy Auditor

Accomplished and dynamic bilingual professional with a proven history of managing pharmacies and managing pharmacy clinical and claim auditing programs. Skilled in working with data and related processes to ensure government, corporate and regulatory compliance. Skilled interpersonal communicator able to work as part of a cross-functional team or independently. Experience managing teams in person and remotely.

•Compliance and Clinical Chart and Data Review Auditing

•Business Strategies

•Collaboration

•Customer Relations

•Risk Mitigation

•Provider and Patient Communication

•Process Improvements

•Documentation

•Problem Resolution

Education

MBA: Health Care Management Boston University Graduate School of Management

Master of Public Health: Health Services Boston University School of Public Health

Bachelor of Science in Pharmacy Rutgers University

Currently Enrolled: Comprehensive Medication Management Certificate Program University of Florida

Career Experience

Director of Operations, Specialty Audit, Conduent Payment Integrity Solutions 2015 to October 2020

Client Account Manager, Pharmacy Audit 2017 to October 2020

Audit Manager 2010 to 2015

Pharmacy Auditor 2006 to 2010

Oversaw a high-performing team of 20 auditors and coordinators as well as multiple client accounts consisting of commercial insurers and state Medicaid plans. Provided integral oversight to audit strategies and revenue expectations. Communicated regularly with clients to anticipate and resolve issues. Responsible for crafting supporting documentation for appeal proceedings and serve as a key representative for Conduent at appeal hearings.

Successfully managed teams of auditors both in-person and remotely.

Implemented process improvements to auditing tools to include onboarding new audit software in collaboration with IT.

Developed queries to proactively identify and target clinically inappropriate therapy, outlier billing practices, and policy non-compliance, in collaboration with the data team.

Conducted retail pharmacy, home infusion therapy, and DME claim and compliance audits with comprehensive evaluations of source documents and claims data to validate and record all audit findings.

Prior experience as a Staff Pharmacist, Floating Pharmacist and Pharmacy Supervisor at Brooks Pharmacy, Eckerd Pharmacy, Omnicare Pharmacy, and Pathmark Pharmacy from 1996-2006.

Licensed in CT and NJ. Immunization License in NJ. Bilingual English/Spanish.

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