Donny L. Horn
Winnetka,CA
Summary
Experienced EDI Coordinator with detail-oriented, systematic and conscientious approach to facilitating smooth and error-free transmissions. Data-driven, resourceful and hardworking with knowledge and fortitude to tackle any challenge. Bringing 20+ years of experience working with electronic data interfaces within supply chain management environments and operations supervisor experience in the field of insurance claims and processing. Dependable, prompt, motivated and take pride in a job well done. Seeking to work for a company that offers job security and equal opportunity for self-advancement.
Overview
27
27
years of professional experience
Work History
EDI Coordinator
Clinicas Del Camino Real Inc.
Camarillo, CA
07.2017 - Current
- Administer all receiving and sending of all EDI documents and perform troubleshoot on all processes to resolve all content issues and map problems.
- Prepared all control job queues and control Ethernet devices.
- Manage all service calls and provide technological support to resolve all issues and maintain all processes to manage all inbound and outbound data.
- Provide technical support to all EDI application and monitor all inquiries for enrollment and payments.
- Transmitted records and files to customers efficiently to maintain operational timelines.
- Built and deepened positive and productive relationships with business partners.
- Tracked files from origin to destination and troubleshot errors.
- Designed and implemented system security and data assurance.
Operations Supervisor
Platinum Health Systems, LLC
Torrance, CA
06.2011 - 06.2017
- Performance Evaluation
- Policy Implementation Processing Authorizations
- Eligibility Request
- Scan Claims Through Portal
- Inventory Reports
- Weekly Auth Reports Weekly & Monthly Customer Service ( Incoming & Outgoing) Mail Room ( Incoming & Outgoing)
- Security Logins For Employees Only
- Add Members & Non Contracted Providers Into The System.
- Processed inbound and outbound shipments with high accuracy and efficiency by effectively directing associate teams and managing inventory processes.
- Enforced regulatory and company policy compliance to improve workplace and employee safety and readiness.
- Created and implemented strategies for improving operational efficiency and accuracy.
- Performed root cause analysis in deficient areas to identify and resolve central issues.
- Encouraged and promoted ideas aligned to business needs and benefits.
Claims Examiner
La Vida Medical Group
Torrance, CA
10.2004 - 04.2011
- Virtual Independent Contractor
- Claims Processor
- Data Entry
- Member & Providers Eligibility
- Reviewed and analyzed suspicious and potentially fraudulent insurance claims.
- Researched claims and incident information to deliver solutions and resolve problems.
- Conducted day-to-day administrative tasks to maintain information files and process paperwork.
Customer Service Rep II
Maxicare Health Plan Inc.
Los Angeles, CA
05.2000 - 09.2004
- Interaction With Members & Providers Regarding
- Benefits
- Claims
- Eligibility
- Pharmacy
- Primary Care Physicians
- Medical Group Transfers
- Offered advice and assistance to customers, paying attention to special needs or wants.
- Responded to customer requests for products, services and company information.
- Answered customer telephone calls promptly to avoid on-hold wait times.
Authorization Clerk
Harriman Jones Medical Group
Los Angeles, CA
06.1997 - 05.2000
- Processing Authorizations
- Eligibility Request
- Mailing & Coordinating Hourly Mail Runs
- Answered Heavy Phone Calls
- Provided Great Customer Service
- Devoted special emphasis to punctuality and worked to maintain outstanding attendance record, consistently arriving to work ready to start immediately.
Education
High School Diploma - General, Computer Technology
Washington Preparatory High School
Certificate - Computer Engineering Technology
West Valley Occupational Center
Skills
- Maintains strict confidentiality
- HIPAA compliance
- In-depth claims knowledge
- Exercises good judgment
- Provider research
- Report analysis
- Knowledge of HMOs, Medicare
and Medi-Cal - Strong work ethic
- Proven patience and self-discipline
- Database tracking
- Storage virtualization
Timeline
EDI Coordinator
Clinicas Del Camino Real Inc.
07.2017 - Current
Operations Supervisor
Platinum Health Systems, LLC
06.2011 - 06.2017
Claims Examiner
La Vida Medical Group
10.2004 - 04.2011
Customer Service Rep II
Maxicare Health Plan Inc.
05.2000 - 09.2004
Authorization Clerk
Harriman Jones Medical Group
06.1997 - 05.2000
High School Diploma - General, Computer Technology
Washington Preparatory High School
Certificate - Computer Engineering Technology
West Valley Occupational Center