Kristen Horton
Crossville
Summary
Results-driven Audit Leader with expertise in financial analysis, risk assessment, and regulatory compliance. Skilled in enhancing internal controls and driving process improvements while fostering collaboration and effective stakeholder communication. Seeking to apply analytical and strategic problem-solving skills in a sales-focused role.
Overview
8
8
years of professional experience
Work History
Quality Review and Audit Lead Analyst
Healthcare Solutions Corporation
Remote
05.2020 - Current
- Coordinated auditing of data related to CMS processes, enhancing data integrity and compliance.
- Evaluated the effectiveness of implemented solutions post-audit, ensuring ongoing compliance with recommendations.
- Served as a trusted advisor to senior management on matters relating to internal controls, risk management, and governance.
- Mentored junior auditors, providing guidance on best practices and professional development.
- Identified and resolved problems through root cause analysis and research.
- Acted as a subject matter expert on nursing care delivery best practices during accreditation visits from external agencies.
- Advocated for a culture of transparency surrounding quality assurance findings, fostering accountability among all levels of staff members within the organization.
- Reviewed medical records for accuracy and completeness, improving care coordination among healthcare providers.
- Presented findings and strategic recommendations to senior management for informed decision-making.
- Streamlined audit processes, reducing turnaround times for audit completion and improving overall audit efficiency.
- Ensured adherence to internal controls by evaluating operational processes and governance frameworks.
- Managed multiple simultaneous audits, prioritizing tasks effectively to meet deadlines without compromising quality.
- Reduced risk exposure by identifying control weaknesses and recommending improvements.
Case Management Analyst
The Cigna Group
Birmingham
07.2019 - 05.2020
- Performed prospective, retrospective and concurrent utilization reviews per specified state and national guidelines.
- Navigated CMS guidelines and regulations to establish medical necessity for authorization requests.
- Selected by supervisor to join audit review team and contributed to improved oversight of processes.
- Managed electronic health record systems, ensuring data integrity and accuracy.
- Reviewed and updated medical coding, enhancing documentation compliance.
- Compiled statistical information from medical records for use in research studies.
- Monitored quality assurance processes related to medical record keeping.
- Reviewed medical documents for coding accuracy and completeness.
Licensed Practical Nurse
Huron County Medical Care Facility
Bad Axe
01.2018 - 05.2019
- Administered medications and monitored patient vital signs to ensure optimal health.
- Provided direct patient care, including bathing, dressing, and feeding residents.
- Observed changes in patient's condition and reported any significant changes to the registered nurse or physician.
- Documented patient progress and communicated changes to healthcare team.
- Implemented infection control measures to ensure safety within the facility.
- Assisted staff with medical procedures and maintained a clean environment.
- Trained new staff on facility protocols and best practices to enhance patient care quality.
- Provided companionship and active listening to support emotional well-being of residents.
Education
Associate of Science - Practical Nursing
St Clair County Community College
Port Huron, MI12-2017
Bachelor of Science - Business And Managerial Economics
Oakland University
Rochester, MI05-2011
Skills
- Quality assurance
- Data auditing
- Internal controls
- CMS regulations
- Risk management
- Root cause analysis
- Attention to detail
- Problem solving
- Client engagement
- Team collaboration
- Effective communication
Timeline
Quality Review and Audit Lead Analyst
Healthcare Solutions Corporation
05.2020 - Current
Case Management Analyst
The Cigna Group
07.2019 - 05.2020
Licensed Practical Nurse
Huron County Medical Care Facility
01.2018 - 05.2019
Associate of Science - Practical Nursing
St Clair County Community College
Bachelor of Science - Business And Managerial Economics
Oakland University