Kelsey Lane
Galloway,OH
Summary
Detail-oriented Quality Review and Audit Analyst with over 10 years in healthcare operations, prior authorization, and compliance. Expertise in enhancing quality performance, identifying trends, and resolving complex issues in fast-paced environments. Committed to supporting staff development and ensuring adherence to regulatory standards.
Overview
13
13
years of professional experience
Work History
Quality Review and Audit Analyst
Cigna
06.2022 - 04.2026
- Audit employee work to ensure compliance with company policies and quality standards
- Coached employees on accuracy and performance, enhancing overall compliance
- Collaborated with peers and leadership to standardize auditing processes
- Identified and reported trends, contributing to continuous improvement initiatives
- Maintain accurate audit records and monitoring outcomes
- Support new hire training, client listening sessions, and special projects
Administrative Assistant
Astute Technology
Columbus, OH
12.2017 - 12.2022
- Managed calls, emails, scheduling, and meeting coordination to facilitate smooth communication and workflow
- Coordinated travel arrangements and maintained office supply inventory to ensure resources were available for daily operations
- Maintained employee attendance records and organized office operations to support effective team management
- Prepared presentations and documentation to support business needs
Resolution Specialist (Coverage Review Department)
Express Scripts
Dublin, OH
11.2018 - 06.2022
- Serve as a point of contact for prior authorization representatives to resolve complex issues
- Review clinical information to support prior authorization decisions
- Processed urgent requests, ensuring timely authorization to prevent expirations
- Identified and reported trending issues, enhancing quality and workflow processes
- Collaborate with pharmacy teams, client services, and patient care advocates
- Coached and guided staff, fostering improvements in quality and performance
- Assist with escalated cases and high-priority requests
Prior Authorization Specialist
Express Scripts
Dublin, OH
12.2014 - 12.2017
- Reviewed prior authorization requests to ensure adherence to clinical guidelines
- Communicated with provider offices to secure necessary clinical information for authorization
- Collaborated with pharmacists to reach final authorization decisions, enhancing overall approval accuracy
- Ensured compliance with HIPAA and documentation standards
- Met productivity and turnaround time requirements
Resolution Team Lead
Express Scripts
Dublin, OH
11.2013 - 12.2014
- Resolved escalated customer issues, providing timely support and ensuring customer satisfaction
- Collaborated with departments to efficiently address member concerns, enhancing overall service delivery
- Coached staff, identifying recurring issues to drive process improvements
Patient Care Advocate
Express Scripts
Dublin, OH
11.2012 - 11.2013
- Achieved quality assurance score of 97% through consistent adherence to service standards
- Resolved customer complaints while educating members on benefits to enhance their understanding
- Managed high-volume calls regarding prescriptions, coverage, and billing to ensure timely assistance
Education
Bachelor of Arts (BA) - Business Administration
American Intercontinental University
Skills
- Quality Assurance and Auditing
- Regulatory Compliance (HIPAA)
- Documentation Review
- Trend Analysis and Reporting
- Data Analysis
- Process Improvement
- Prior Authorization Processing
- Microsoft Office (Excel, Word, PowerPoint, Outlook)
- Time Management and Attention to Detail
- Coaching and Staff Development
- Customer Service and Escalation Management
Timeline
Quality Review and Audit Analyst
Cigna
06.2022 - 04.2026
Resolution Specialist (Coverage Review Department)
Express Scripts
11.2018 - 06.2022
Administrative Assistant
Astute Technology
12.2017 - 12.2022
Prior Authorization Specialist
Express Scripts
12.2014 - 12.2017
Resolution Team Lead
Express Scripts
11.2013 - 12.2014
Patient Care Advocate
Express Scripts
11.2012 - 11.2013
Bachelor of Arts (BA) - Business Administration
American Intercontinental University