Rayburn (Von) Prater
Murfreesboro,TN
Summary
I am a detail-oriented professional with extensive experience in problem-solving, customer relations, and process improvement. Particularly in Healthcare Claims, Manufacturing, and more recently Postal/E-Commerce. I am eager to leverage these strengths in a new role, contributing to a team environment and the success of that role.
Overview
15
15
years of professional experience
Work History
Inbound Associate
Amazon
Murfreesboro, TN
08.2023 - Current
- Processed customer orders efficiently in high-volume environment.
- Managed inventory levels using Amazon's warehouse management system.
- Collaborated with team members to meet daily productivity targets.
- Resolved customer inquiries and issues through effective communication.
Production Associate
Kasai North America, Inc. Manchester Plant
Manchester, TN
11.2020 - 12.2022
- Operated on a line responsible for manufacturing completed door inserts for Nissan vehicles.
- Worked as an associate making the supporting pillars to the roof of a vehicle.
- Worked in the injection portion of the factory, both producing and inspecting finished products.
- Worked on several presses within the site. This included producing, overseeing, and inspecting the final product to meet both internal and clients specifications according to our production standards.
- Worked in Fiberglass department, making sheets of fiberglass. This includes mixing compounds within one hundredths of specifications and operating machinery to produce glass.
Medical Billing and Collections Specialist
Results Physiotherapy
Franklin
04.2016 - 03.2020
- Analyzed and Corrected front end rejections in billing system. This includes missing information, coding issues, cob conflicts, and etc.
- Prepared Appeals for Medicare Advantage and other insurances in a professionally prepared package.
- Advised management of claim denial and rejection trends and suggested solutions to resolve these trends. This includes contact with Insurance and requests to make amendments to contracts held with the insurance.
- Reducing AR for different insurance groups. (As much as 20% reduction of 1.4 million in 30 day project that I initiated and resolved independently).
- Worked with BCBS in over 10 states, Cigna, Aetna, UHC, Medicare Advantage, Humana, and various other commercial plans. I also have some knowledge of both MVA and Workers Compensation payers.
- Onsite training of other team members.
Patient Account Representative
Xtend Healthcare
Nashville, TN
12.2013 - 03.2016
- Managed patient accounts for multiple hospital systems housed by several different teams within the company. It was my job to address insurance denials and resolve the issue with payment from the insurance.
- Researched and determined the claim rejection/denial reason. Following that I made necessary fixes based upon the insurance's specific guidelines and the patients benefits.
- Contacted and worked with patients to resolve medical denials. In some cases this required discussions with insurance and patient together.
- Because Xtend workers directly with hospitals staff on and off-site I became familiar with multiple systems (Oracle, Epic, etc. EMS systems).
Denials Coordinator
CGS Medicare
Nashville, TN
01.2013 - 11.2013
- The ALJ team is the 3rd and final level of appealing a claim submitted by a provider within Medicare.
- The job duties included both gathering and preparing documentation for CGS's Medical/Legal team to present in ALJ hearings, and responsible for upkeep on Dr. Edward's files and schedule.
- CGS is a company that bids on Medicare's offers to handle portions of their claims and appeals. I worked on a small team with a Doctor who handled hearings on ALJ appeals.
- This was a temporary contract job that didn't get renewed with Medicare, so I lost my position.
Operations Support
MedSolutionsUS
Franklin, TN
03.2011 - 01.2013
- Handled support issues with a ticket system generated by providers and patients.
- Worked with providers and patients to solve issues with pre-authorizations.
- My last role at Medsolutions was working on the P2P team. When a prior authorization is denied the patient`s provider would speak to one of our Physicians about the medical necessity of the treatment in an effort to obtain an authorization for the process. This is a similar process to the ALJ process I assisted with at CGS.
Education
High School Diploma -
Warren County Highschool
McMinnville, TN05.2009
Skills
- Microsoft Office, Excel, Word, and etc
- Computer hardware
- Customer Service
- Teamwork
- Support, Problem Solving, and attention to detail
- Willingness to learn and help others
- Extensive experience with Medical records, Claims Denials/Rejection, Claims Billing, Insurance follow-up, some Medical Coding, CMS-1500 and UB-04 forms, and Claims appeals
Timeline
Inbound Associate
Amazon
08.2023 - Current
Production Associate
Kasai North America, Inc. Manchester Plant
11.2020 - 12.2022
Medical Billing and Collections Specialist
Results Physiotherapy
04.2016 - 03.2020
Patient Account Representative
Xtend Healthcare
12.2013 - 03.2016
Denials Coordinator
CGS Medicare
01.2013 - 11.2013
Operations Support
MedSolutionsUS
03.2011 - 01.2013
High School Diploma -
Warren County Highschool