Ciera Clark
Canton
Summary
Highly qualified Compliance Auditor with relevant experience in ensuring organizational adherence to industry regulations and laws. Strengths include comprehensive knowledge of auditing principles, keen analytical skills, and the ability to conduct thorough risk assessments. Previous work has resulted in improved regulatory compliance strategies, reduced financial risks, and enhanced internal controls.
Overview
16
16
years of professional experience
Work History
Pharmacy Compliance Auditor, Specialty & Fertility Programs
BirdiRx
10.2025 - Current
- Conduct onsite and desk compliance audits of specialty pharmacies dispensing fertility medications on behalf of Ferring Pharmaceuticals.
- Review prescription documentation, dispensing workflows, inventory controls, billing practices, and prior authorization compliance.
- Identify compliance gaps, documentation deficiencies, and financial risk exposure associated with high-cost specialty drugs.
- Prepare formal audit reports and support corrective action plans (CAPs) and follow-up validation.
- Travel nationwide to manage multiple concurrent audit engagements while meeting strict timelines.
Quality Assurance Specialist II
AcariaHealth
04.2025 - 10.2025
- Audited 36 agents weekly through structured call reviews to ensure compliance with quality and policy standards.
- Identified trends, compliance risks, and training opportunities; served as subject matter resource.
- Coached team members to reinforce adherence to procedures and performance expectations.
Account Install Specialist
Prime Therapeutics (via Insight Global)
06.2025 - 08.2025
- Interpreted and entered benefit plan designs into AS400 claims processing system.
- Revised benefit plans with accuracy to support implementations and quality assurance.
Health Care Analyst, Medicare Part D Regulatory Compliance
Blue Cross Blue Shield of Michigan
01.2018 - 01.2024
- Served as SME on Medicare Part D operations, claims processing, and provider data integrity.
- Resolved escalated provider and member issues related to reimbursement and network discrepancies.
- Created dashboards tracking STARS measures and prepared HPMS submissions for CMS audits.
Lead Senior Pharmacy Auditor
Blue Cross Blue Shield of Michigan
01.2010 - 01.2015
- Conducted onsite and desk pharmacy audits validating compliance with contracts and regulations.
- Identified fraud, overbilling, and deficiencies; drove corrective action and financial recovery.
- Audited and resolved high-volume claims using query-based validation.
Education
Healthcare Law & Regulation
Florida State University
Bachelor of Science - Health Sciences
Central Michigan University
Skills
- Pharmacy compliance audits
- Specialty and fertility pharmacy programs
- Medicare Part D expertise
- PBM operations management
- Corrective action plans
- Regulatory compliance (CMS, HIPAA, URAC)
- Billing and reimbursement review
- Provider oversight
- Risk identification and mitigation
Timeline
Pharmacy Compliance Auditor, Specialty & Fertility Programs
BirdiRx
10.2025 - Current
Account Install Specialist
Prime Therapeutics (via Insight Global)
06.2025 - 08.2025
Quality Assurance Specialist II
AcariaHealth
04.2025 - 10.2025
Health Care Analyst, Medicare Part D Regulatory Compliance
Blue Cross Blue Shield of Michigan
01.2018 - 01.2024
Lead Senior Pharmacy Auditor
Blue Cross Blue Shield of Michigan
01.2010 - 01.2015
Healthcare Law & Regulation
Florida State University
Bachelor of Science - Health Sciences
Central Michigan University