Carli Horne
Lancaster
Summary
Detail-oriented Prior Authorization Specialist with strong skills in insurance verification, patient coordination, and compliance. Proven ability to manage authorization processes effectively while maintaining accurate database records.
Overview
20
20
years of professional experience
Work History
Prior Authorization Specialist
Carolina Urology Partners
Rock Hill
10.2024 - Current
- Contacted insurance carriers to secure authorizations, notifications, and pre-certifications for patients, ensuring timely access to necessary treatments.
- Reviewed clinical documentation to ensure compliance with authorization guidelines.
- Coordinated with healthcare providers to gather necessary information for approvals.
- Communicated with insurance providers to verify patient coverage details.
- Responded promptly to inquiries from providers, patients, and payers about prior authorization status, facilitating clear communication and resolution.
- Maintained accurate records of all authorization activities in the database system, supporting compliance and efficient retrieval of information.
Admissions Registrar
MUSC Lancaster Medical Center
Lancaster
05.2018 - 10.2024
- Registered patients upon arrival using electronic health record systems.
- Collected patient information and verified insurance details efficiently.
- Coordinated with clinical staff to ensure smooth patient transitions to treatment areas.
- Updated and managed patient records within the hospital's information systems accurately.
- Maintained patient confidentiality in accordance with HIPAA regulations.
- Verified insurance information and maintained accurate patient records.
- Managed patient check-in and registration processes efficiently.
- Coordinated appointment scheduling for multiple healthcare providers.
- Utilized electronic health record systems for data entry and retrieval.
- Trained new front desk staff on procedures and best practices.
Home Health Aide
Senior Helpers
Lancaster
01.2015 - 01.2018
- Assisted clients with daily living activities and personal care needs.
- Documented client progress and care activities in detailed reports.
- Maintained a clean and safe environment for clients at all times.
Office Manager
Home Oxygen & Medical Supply Inc.
Lancaster
01.2006 - 08.2009
- Managed daily office operations for a medical supply company.
- Oversaw billing and insurance claims processing for clients.
- Implemented filing systems for improved document management and retrieval.
- Maintained filing system for records, correspondence and other documents.
- Answered phone calls, responded to emails, routed mail and coordinated courier services.
Education
High School Diploma -
Lancaster High School
Lancaster05-2008
Some College (No Degree) - Associate Degree Nursing Program
York Technical College
Rock Hill, SCSkills
- Authorization management
- Insurance verification
- Precertification requirements
- Authorizations
- Clinical documentation
- Patient coordination
- Electronic health records proficiency
- Knowledgeable in multiple EHR systems
- Database management
- Customer relationship management
- Healthcare communication
- Time management
Proficient multiple EHR systems
- Epic
- Meditech
- NextGen
Timeline
Prior Authorization Specialist
Carolina Urology Partners
10.2024 - Current
Admissions Registrar
MUSC Lancaster Medical Center
05.2018 - 10.2024
Home Health Aide
Senior Helpers
01.2015 - 01.2018
Office Manager
Home Oxygen & Medical Supply Inc.
01.2006 - 08.2009
High School Diploma -
Lancaster High School
Some College (No Degree) - Associate Degree Nursing Program
York Technical College