Gwendolyn Van Koningsveld
Milwaukee,WI
Summary
Seasoned Senior PBM Auditor with substantial background in conducting comprehensive external audits. Possess deep understanding of PBM contract terms, financial guarantee reporting, and complete pricing audit reconciliation. Exceptional ability to identify discrepancies and recommend effective controls for protecting Rx pricing guarantees. Track record of improving operational efficiency through strategic auditing standardization initiatives.
Overview
17
17
years of professional experience
Work History
Senior Auditor, Pricing Audit Lead
Pharmaceutical Strategies Group (PSG)
, TX
01.2017 - Current
- Served as the Pricing Audit Lead in the audit team, sharing knowledge and support. Took the audit team from entry level SQL skills to intermediate/advanced level. Helped to cultivate a positive team culture.
- Conducted audits with full reconciliation to identify potential areas of non-compliance.
- Collaborated with external partners to complete audits.
- Reviewed and interpreted PBM contracts for pricing terms and definitions, gaining insight regarding how contract language can impact the pricing guarantees.
- Built foundational SQL query templates to calculate and reconcile PBM pricing performance.
- Constructed SQL scripts that would clean up PBM reconciliation files to make them usable for comparison.
- Created audit reports to present the results.
- Ensured timely completion of all assigned tasks within set deadlines.
Manager of Analytics
ARMSRx
Windermere, FL
09.2015 - 09.2016
- Managed and oversaw all aspects of data analytics, including data modeling, audits, reconciliations, and ad-hoc analyses, while producing savings analyses on PBM data received in order for clients to determine the most cost-effective choice in Rx benefits. Partner in PBM implementation, pre- and post-go-live testing.
- Performed complex claims analysis so that clients can make strong decisions about their Rx benefits.
- Initiated savings projections for benefit changes, copay modeling, auditing, the reconciliation of audit outcomes, and custom analysis requests.
- Monitored performance guarantees as stipulated in the clients' contracts; led the testing of specific benefit plans and formularies.
Senior Data Analyst
TriCast
Milwaukee, WI
06.2012 - 06.2015
- Analyzed and identified potential loopholes in PBM contract pricing language that could be costing the client money.
- Communicated data requirements through project kick-off calls.
- Created and maintained ETL SOP documents, FTP user accounts, and managed automated tasks moving files between FTP and directories.
- Translated data layout documents into SQL format files, and adapted BCP and PowerShell scripts for loading text files; mapped raw file fields to standardized fields by adapting SQL insert scripts.
- Loaded data through star structures and data stores to production.
Data Analyst
Trivantage
Milwaukee, WI
04.2008 - 06.2012
- Conducted the review, analysis, and interpretation of PBM contracts to determine the appropriate audit methodology, applied the methodology to the internal audit application for automated reporting, and created/developed ad-hoc analyses using SQL queries.
- Managed data flow, investigated and identified audit outcome discrepancies by comparing output files with SQL queries, and reviewed findings with internal clients.
- Communicated data requirements through kickoff calls, created and maintained ETL SOP documents, and translated data layout documents into SQL Loader scripts for loading text files.
- Mapped raw file fields to standardized fields using SQL transform scripts.
- Performed all aspects of data QA, and adapted existing automated reports.
Education
Bachelor of Science - Psychology/Sociology
University of WI - Milwaukee
Milwaukee01-1998
Skills
- SQL / Transact-SQL (T-SQL)
- ETL
- Microsoft Excel
- Data Analysis
- Data Reconciliation
- Claims Auditing
- Auditing
- External Audit
- Pricing Analysis
Timeline
Senior Auditor, Pricing Audit Lead
Pharmaceutical Strategies Group (PSG)
01.2017 - Current
Manager of Analytics
ARMSRx
09.2015 - 09.2016
Senior Data Analyst
TriCast
06.2012 - 06.2015
Data Analyst
Trivantage
04.2008 - 06.2012
Bachelor of Science - Psychology/Sociology
University of WI - Milwaukee
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