MICHAELEE CADESTIN, MPH, BHA

**** ******** ***** *** **** 1

Jacksonville, FL 32256

904-***-****

ad4wwt@r.postjobfree.com

OBJECTIVE

Seeking a position with a growing company as a Medical Support Assistant where my training, education, time served in the military, and experiences can be put to good use.

EXPERIENCE

Program Support Assistant June 2022 to Present

Veterans HCHV/CRRC Program Department of Veteran Affairs

605 West Beaver Street

Jacksonville, FL

• Providing clerical and administrative support to the Social Workers that are assisting

homeless/ or at risk of homelessness Veterans

• Assisting the Social Worker with assessments done on the Veteran to determine what

programs are available

• Posting over 15 employees time accurately and in a timely manner

• Transporting Veterans to various different classes and programs that the VA has to offer

• Assisting Clara White employees in the garden to help with the Veterans enrolled in the

program

• Volunteering to help do various different duties with the Clara White Mission

• Maintaining an excel spreadsheet monthly to report to supervisor the number of

Veterans that received services for the month

• Helping Veteran fill out paperwork to be eligible for healthcare services

• Knowledge of HINQ to see if Veteran is eligible for services, requesting HINQ's for Social

Workers to print out for Veterans packets into programs

• Filling out 10-10EZ forms to be turned into clinic to see if Veteran is healthcare eligible

• Helping Dietitian coordinate trips for the Veterans.

• Ordering supplies, making copies, faxing packets and making sure proper paperwork is

turned into the enrollment clinic in a timely manner.

• Entering data into survey manager for all staff on a daily basis

• Requesting copies of DD214 at Veterans request.

• Updating Veterans information in Vista/CPRS

• Completing assessments on Veterans to determine their eligibility into a VA program

• Coordinating with JOPC to make sure Veteran is compliant and aware of appointments

• Transporting Veterans in crisis to the JOPC or Shands hospital

• Taking minutes for our monthly HCHV staff meeting

• Coordinating outreach schedule and making sure is up to date monthly.

• Preparing excel spreadsheet for government vehicle usage and miles driven on a

monthly basis.

• Clearing all employee exceptions in Vista

• Coordinating schedule for the CRRC team to make sure there is always coverage.

• Helping coordinate and facilitate group meetings for Veterans in the various homeless

programs

• Coordinating competency files for new employees

• Coordinating with community agencies to help Veterans get job training, or job

opportunities

• Referring Veterans that are at risk of homelessness to Supportive Services for Veterans

Families

• Preparing and printing documents of Veterans so that the local homeless coalition can

track these Veterans and provide other services as needed

• Referring Veterans to various food pantries throughout our community

• Maintenance on all government vehicles assigned to HCHV

• Assisting Veterans with filling out proper paperwork for Disability Review Board

• Assisting Veteran to fill out packet for Changing Homelessness to seek assistance with

move in costs such as deposit and application fee.

• Assisting Veteran with finding housing, the application process and all other required

documents that are needed for approval for a unit

• Correspond with outside agencies to seek help with keeping the Veteran housed.

• Assist Veterans in identifying their skills, strengths, supports and the resources needed

to aid them in achieving those goals

Affairs-Advanced Medical Support Assistant Gainesville, FL June 2019-

Sept 2020 (Community Care)

• Monitor and completes scheduling, authorization, and indexing procedure on assigned

community care consults and informs team of

concerns, to minimize patient problems or delays in care. Includes returning phone calls

within 1 business day

• Call patient to discuss scheduling preference when not identified on the Community

Care consult; mailing the Veteran’s scheduling letter

• Send the authorization Refdoc packets to the vendor and confirming receipt. Scheduler

will follow Community Care scheduling operating procedure; Follows other

business rules established in current scheduling directives. (VHA Directive 1230.)

Schedule’s patients using the PID established by the patient

• Complete Appointments are reviewed frequently, and records request are completed

for proper indexing of community

medical records. Consults will be maintained and scheduled in a timely manner,

adhering to national and local parameters; All consults to be

reviewed administratively, status changed within two business days of the consult

creation (pending to active), all active consults are to be

scheduled within 14 days (active to scheduled). Consult priorities are reviewed daily.

demonstrate the ability to schedule/reschedule. Schedule/reschedule will be completed

within 14 business days of initial order. Proper documentation will be utilized

on the Community Care consult utilizing consult toolbox. Notating the appropriate

scheduled appointment and authorization number. The

Auditing Tool will be utilized to provide the appropriate amount of correct or not correct

scheduling practices.

Veterans Affairs- Advanced Medical Support Assistant Jacksonville, FL Oct

2020 to Present

• Coordinate with the patient care team to review the clinic utilization by using various reports

• Ensure that the clinic setup is closely monitored to effectively support the needs of the clinic,

and makes any necessary adjustments

• Develop/maintains effective and efficient communication with the patient, interdisciplinary

team, VA medical centers, and other agencies

• Facilitate/process secure messaging with the patient and team; notifies patients of normal lab

results.

• Develop and manages a tracking system for follow up care such as consults, tests, etc

• Participate in team huddles and team meetings to manage and plan patient care

• Set priorities and deadlines, adjusting the flow and sequencing of the work to meet team and

patient needs

• May work with the team to reinforce the plan of care and self-help solutions and entering

appropriate information into the electronic record

• Monitor pre-appointment requirements to assure readiness for patient visit/procedure (e.g.,

X-ray, lab work).

• Manage electronic wait list to verify and validate accuracy and resolve issues.

Veterans Affairs - Medical Reimbursement Technician Orlando, FL Feb 2019 to

June 2019

• Perform verification of patients' insurance coverage for inpatient/outpatient services; enters

information and maintains databases

• Documents pre-admission requirements, and identifies patients requiring second opinions

• Performs reimbursement billing activities, including consideration of professional and facility

services, sharing agreements, Tricare, Champ VA, Medical, and Pharmacy billing

• Validate claims for billing purposes ensuring eligibility and refers questionable coding for

review; monitors reports to assure all possible billable cases are processed, ensuring proper

sequencing of diagnostic and procedural codes; tracks, reviews, and corrects denials.

• Perform third-party collections from insurance companies, and for accounts receivables

including humanitarian, Department of Defense, Tricare, tort feasor, workman's

compensation, ineligibility, etc.

• Perform research, resolve problems, and post payments, adjustments, denial codes, and nonpayment collections

• Verify accuracy of payments, resolving discrepancies, and closing and auditing accounts.

• Responsible for the integrity of the insurance databases, for updating information in the

system, and generating reports. Maintains a tracking system on Debt Management and the

Department of Treasury Off-set program.

• Communicate with insurance companies and patients answering questions/inquire, and

explains health care services eligibility and entitlements to patients. Provides input for

responding to Congressional inquiries

CHEQR -Volunteer Jacksonville, FL Feb 2016 to Jan 2019

May assist in complex interventional, therapeutic, greater than minimal studies with direction but does

not have overall responsibility for these studies. Screens, enrolls, and recruits research participants.

Coordinates schedules and monitors research activities and subject participation. Recognizes adverse

events, protocol deviations, and other unanticipated problems and reports appropriately. Collects,

abstracts, and enters research data. Performs administrative and regulatory duties related to the study

as assigned.

UF Health Jax Jacksonville, FL Financial Representative/Employee Relations

Specialist/Lead/Assistant Supervisor Nov 2016 to Feb 2019

• Help to maintain a positive employee relations climate by proactively providing guidance to

managers and responding to employee inquiries

• Assign work and monitors assignments to ensure work is completed accurately and by identified

deadlines

• Responsible for planning and coordinating in-service training, on the job training. and other

education opportunities

• Manages the scheduling program within the clinic and coordinates appointments for services not

available at the clinic

• Monitor clinic utilization, bookable hours, completion of encounters, and other workload data.

Compiles into regular reports and take action to address inefficiencies as needed

• Provides guidance to Unit personnel on the proper preparation, processing, and maintenance of the

program functions and documents.

• Conducts multiple Performance Improvement initiatives, helping assure accuracy of patient care

data.

• Identifies problems, either potential or real, and determines, in priority order, actions necessary to

resolve problems

• Participates in recruitment of administrative personnel, interviews and selection processes

•Work collaboratively with employees and departmental leadership in carrying out their responsibilities

on employee relations matters

•Participate in the investigation and resolution of ongoing employee relations problems, such as

working conditions, disciplinary actions, and employee appeals and grievances

•Provide guidance and recommendations for problem resolution to departmental leaders and

employees; Helps employees and departmental leadership settle work-related conflicts through advice

and guidance

•Support the Employee Relations Manager and Legal in conducting employee relations investigations

•Strong Interpersonal skills

•Ability to communicate with people of diverse backgrounds

•Knowledge of insurance requirements

•Excellent decision-making skills and initiative

•Detail oriented

•Ability to prioritize tasks and organize work flow

•Able to perform cashiering functions

•Able to handle stressful situations in a professional manner

•Knowledge of PC, Windows environment, and 40 wpm typing skills.

•Collect, review, discuss, and document demographic, insurance, and financial information with patients

•Respond to and resolve variety of account, billing and payment issues from patients and customers

•Follow approved guidelines and policies regarding routine patient and payer interactions

•Make independent decisions that require individual and/or team analysis, reasoning, and problem

solving

•Interpret, apply, and communicate medical and financial aspects of patient care to assure optimal

reimbursement for patients.

•Excellent customer service skills and possess ability to negotiate payment reimbursement from

patients and third-party payers.

Allstate Insurance Jacksonville, FL Claim Benefit Specialist/Worker’s Comp Aug

2016 to Oct 2016

•Making decisions

•Solving Problems

•Planning, Prioritizing and organizing

•Effectively communicating verbally and in writing

•Customer Service

•Determine liability

•Partner with appraisers/estimators to manage vehicle repairs

•Negotiate with customers and other insurance carriers

•Review, examine, develop, and adjudicate or process the entire spectrum of non-fatal and

fatal claims

•Examine and develop reports of injury and death to complete proper disposition of case files

•Verify compensation rates, periods of disability, payment of compensation and Count out

uncontested cases of payments made by insurance carriers

•Evaluate medical reports, information and other types of evidence submitted with claim for

benefits

•Prepare reports, writing and related research activities

•Compile information required in recommendations for resolution of the issues dispute

• Examine claims cases which involve traumatic injuries and primary non-traumatic

injuries. Examines claims for factual sufficiency and legal correctness

• Examine medical reports involving prolonged disability from work for 90 days or more and

complete form CA-27 to place claimant on the automatic roll

• Adjudicate the claim on the basis of written medical and factual evidence secured by

correspondence or through investigation. If evidence does not support a claim incumbent

prepares memo to a higher level examiner stating reasons for recommending rejection of

claims

• Review and processe death claim cases and examines all appropriate forms and certificates

such as, birth, death, marriage certificate, and autopsy reports

• Identifie the specific problems in each given· case in order to determine the types of

information required. Analyzes the response, makes the decision; this often requires

review and analysis of voluminous and complicated material

Aetna Inc Jacksonville, FL Claim Processor May 2015 to Aug 2016

•Enter claims information into database systems

•Prepare insurance claim forms or related documents and review them for completeness

•Calculate amount of claim

•Post or attach information to claim file

•Transmit claims for payment or further investigation

•Verify and/ or assign key data elements for charge entry such as, location codes, provider #’s,

authorization #’s, referring physician and etc

•Ability to enter charge information into automated billing system

•Ability to correct edits timely and appropriately

•Inform team leader on the status of work and alert team leader of backlogs or issues requiring

immediate attention

•Verifies benefits, policy number, pre-certification requirements, Insurance contact

information, and effective dates of coverage

•Responsible for all reimbursable billing activities including consideration of professional

services and facility services, sharing agreements, Medicare, and pharmacy billing

•Obtains information required for tort cases, workman’s compensation, OWCP, and personal

injury case

•Obtains information required for tort cases, workman’s compensation, OWCP, and personal

injury cases

•Applies payments to the appropriate bill or refunds to the applicable party

•Validates claims for billing purposes ensuring eligibility and referring questionable coding for

review

•Responsible for billing, including humanitarian, tort feasor, workman's compensation and nofault auto accidents

•Performs follow-up on explanation of benefits received from third-party carriers to maximize

revenue and reviews payments to ensure consistency with insurance policy terms.

Novitas-Solutions Jacksonville, FL Credential Specialist/Provider Enrollment

March 2014 to May 2015

•Enroll/re-enroll all eligible providers under which services will be

billed, such as MDs, DOs, PhDs, PAs, ARNPs, CRNAs, etc

•Prepare and distribute enrollment packets for each eligible provider for all applicable carriers

•Obtain UFJP provider number from Accounting upon receipt of initial carrier authorization for

each eligible provider

•Maintain PC database of Provider enrollment information

•Verify physician hospital privileges at all appropriate hospitals

•Verify provider employment start dates with the Office of the Dean

•Follow-up on all open provider enrollment applications with carriers through issuance of

provider numbers

•Maintain records of provider enrollment and certification documentation

•Interact with Information Services to insure timely updates of provider information, including

but not limited to: UFJP provider number, billing locations, and carrier provider numbers in the

IDX system provider dictionary

•Periodically maintain and distribute a complete provider directory, identifying providers and

provider departments, divisions, locations, numbers, status, and approved carriers

•Distribute provider start and termination date information to all appropriate personnel

•Assist providers, clinic personnel and co-workers with enrollment issues and questions

•Inform appropriate personnel and providers of changes in key enrollment issues/policies

•Assist Director of Education, Reimbursement and Analysis with research and analysis for

special projects as assigned.

University of Florida Jacksonville, FL Charge/Follow-up Coordinator May 2013

To March 2014

•Verify completeness of registration information. Add and/or update as needed

•Verify and/or assign financial class

•Verify and enter patient demographic information utilizing automated billing system

•Verify insurance coverage utilizing various online software tools

•Verify and enter appropriate billing information utilizing facility computer systems

•Verify and/ or assign CPT, ICD-9 and Modifier codes are utilized for each patient encounter as

needed

•Verify and/ or assign key data elements for charge entry such as, location codes, provider #’s,

authorization #’s, referring physician and etc

•Ability to recognize the need to establish a case utilizing company policy

•Ability to enter charge information into automated billing system

•Ability to correct edits timely and appropriately

•Inform team leader on the status of work and alert team leader of backlogs or issues requiring

immediate attention

•Contact insurance companies to ascertain the status of claims and identify additional

information needed

•Research and take appropriate action in regard to refunds, payor issues, charge corrections,

etc. with the ability to identify trends

•Ability to identify payor specific guidelines, billing edits, National Correct Coding initiative and

online tools

•Documents notes in the automated billing system regarding patient inquiries, conversations

with insurance companies, clinics, etc, for all actions

•Re-file insurance claims when necessary to the appropriate carrier based on each payors

specific appeals process with the knowledge of timelines

•Complete correspondence request through interaction with payors, patients and/or the clinics

to provided needed information for claims payment

•Review PSR requests and determine course of action

•Inform team leader of the status of work area and alert team leader of backlogs or unresolved

issues

•Identify trends by payor that impact A/R and communicate to leadership (Denials, payment

transfers, etc.)

•Performed special projects assigned by the team leader

•All other duties as assigned by team leader or manager

•Ability to work overtime as needed based on the needs of the business.

•Compare payment to Managed Care Contract, analyzing results as true variances requiring

additional follow up compared to false variances, explained by billing or contractual criteria met

•Pursue identified true variances, trending issues for reporting non-compliance of payer for use

by UF in contract negotiations and balance billing payers for short fall in expected revenue

•Distinguish whether identified operational issues are related to internal or external data

suppliers and act appropriately to provide root cause analysis and aid in carry out of resolution

or interim work around action plan

MD Abstract Jacksonville, FL Abstractor Jan 2011 To Jan 2012

Abstractor

Abstract Medical records

Scans information received into the appropriate section of the EMR.

. Performs data entry using the scanned image and direct keyboard entry using document

abstracting table as a guide

Creates orders/encounters in the EMR as needed to enter/edit results and attach scanned

images and closes them as appropriate

Cross trained to move scanned images into EMR via batch routines

EMR communication pathways to route results to ordering practitioners per EMR Committee

direction

Communicate directly with physicians and providers of service regarding any open encounter

which need to be closed

Maintains high level data accuracy per performance improvement indicatives. QC expectation

is 99% per posting result. 100% of all entries is QC’d within 24 hours of entry

Medicare Advantage experience

Jacksonville, FL

Department of Veterans Affairs Work Study/Administrative Support Assistant

June 2010 To May 2013

• Handle veteran’s paperwork, drop filing, answer phone calls, keying information in the

system

• Maintain and update filing, inventory, mailing, and database systems, either manually or

using a computer

• Compile, copy, sort, and file records of office activities, business transactions, and other

activities Compute, record, and proofread data and other information, such as records or

reports

• Provides utilization support for an organization with frequent organizational functional

changes

• Plans and performs general support services, such as coordination and assignment of

clerical duties and action item coordination

• Answers questions and recommends actions concerning policies and procedures related to

the clinic.

• Type 40 WPM, format, proofread, and edit correspondence and other documents, from

notes or dictating machines, using computers

• Complete work schedules, manage calendars, and arrange appointments Review files,

records, and other documents to obtain information to respond to requests

• Maintain office services by organizing office operations and procedures; controlling

correspondence; designing filing systems; reviewing and approving supply requisitions;

assigning and monitoring clerical functions

• Maintain office efficiency by planning and implementing office systems, layouts, and

equipment’s procurement Design and implement office policies by establishing standards

and procedures; measuring results against standards making necessary adjustments

• Complete operational requirements by scheduling and assigning employees; following up

on work results Keep management informed by reviewing and analyzing special reports;

summarizing information; identifying trends Maintain office staff by recruiting, selecting,

orienting, and training employees

• Maintain office staff job results by coaching, counseling, and7 disciplining employees,

planning, monitoring, and appraising job results Maintain professional and technical

knowledge by attending educational workshops; reviewing professional publications;

• Achieve financial objectives by preparing an annual budget; scheduling expenditures;

analyzing variances; initiating corrective actions

• Contribute to team effort by accomplishing related results as needed

Team Health Jacksonville, FL Coder March 2011 To June 2013

Code over 40 charts daily with 95% Accuracy

Able to resolve 6 to 12 claims per hour

Able to disguise between UB and HCFA claim form

Excellent oral communication

Handle all types of insurance claims and insurance frauds

Process accounts transactions such as accounts payable and receivable

Ensure that the patient is covered by insurance before all procedures are started

Abstracts, interprets and reviews medical record documentation to assign accurate CPT-4

procedure and ICD-9 diagnosis codes for procedures performed n the clinic setting or

procedure rooms

May provide CPT Evaluation and Management codes and ICD-9diagnosis codes for

consultations in the hospital setting

Imputes appropriate modifiers

Define physician documentation as appropriate

Comprehend and applies medical terminology, anatomy, physiology, surgical technology,

pharmacology, and disease processes

Establish knowledge of sequencing diagnoses and procedure codes outlined in the ICD-9-CM

official coding guidelines.

Meet established coding and abstracting quality and productivity standards.

Provide training and/or quality support as directed. Flexible and willing to adapt to changes in

the work environment

Sustain effective and professional communication skills

Display excellent customer service

Devote to a positive departmental image by exhibiting professionalism, teamwork, and mutual

respect

Competent in navigating the electronic medical record and all supporting information

management and billing systems.

Malone Incorporated Jacksonville, FL Inspector Oct 2008 To Jan 2010

Inspected packages for accuracy

Operated forklifts

Inspected packages for damages

Sorted packages by hand

Scan, weight and key packages

Responsible for physical loading of the packages

US NAVY Kingsbay, GA Cook Sept 2001 To Mar 2007

Cook on watch/ Assistant watch captain

Cooked and served 500 + people

Supervised 20 + people

Train workers in food preparation, and in service, sanitation, and safety procedures

Compile and balance cash receipts at the end of the day or shift

Supervise and participate in kitchen and dining area cleaning activities

Resolve customer complaints regarding food service

Control inventories of food, equipment, small ware, and report shortages to designated

personnel

Purchase or requisition supplies and equipment needed to ensure quality and timely delivery

of services

Observe and evaluate workers and work procedures to ensure quality standards and service,

and complete disciplinary write-ups

Specify food portions and courses, production and time sequences, and workstation and

equipment arrangements

EDUCATION

Capella University Jan 2016-Dec 2018

Master’s Degree, Public Health

University of Phoenix Jan 2012-Oct 2014

Bachelor Degree, Health Care Administration

Virginia College Jan 2010-Dec 2011

Associate Degree, Health Care Reimbursement

SUMMARY OF QUALIFICATIONS

Verify accuracy of billing data and revise any errors

Review documents such as purchase orders, sales tickets, charges lips, or hospital records to

compute fees or charges due

Knowledgeable of medical terminology

Type 60 wpm

Knowledgeable of cpt coding, ICD-9 cm coding, HCPCS coding

Knowledgeable of UB-04 claim forms and CMS 1500

Knowledgeable of Microsoft word, excel, PowerPoint

Maintain records, reports and files

Prepare Billing Statements

Approving requests, handling paperwork, and performing day-to-day administrative tasks

Providing information to supervisors, fellow workers, and subordinates.

Identifying underlying principles, reasons, or facts by breaking down information or data into

separate parts

Observing, receiving, and otherwise obtaining information from all relevant sources

Compiling, coding, categorizing, calculating, tabulating, auditing, verifying, or processing

information or data

Monitoring and controlling resources and overseeing the spending of money

Coordinating members of a work group to accomplish tasks

Translating or explaining what information means and how it can be understood or used to

support responses or feedback to others

Combining, evaluating, and reasoning with information and data to make decisions and solve

problems

Developing constructive and cooperative working relationships with others.

Able to identify issues/problems, initiate plans to address and make appropriate and timely

decisions.

Demonstrated management skills, including the ability to direct the management of complex

projects and tasks and monitor progress.

Have strong teamwork, communication, organizational and interpersonal skills.

Tolerate a high degree of ambiguity. Knowledgeable of current healthcare delivery trends,

economic and regulatory issues.

Experience with large administrative and/or clinical databases preferred

Utilize VISTA computer functions to generate reports and to validate and review computer

entry

Use advanced computer skills in word processing to generate work-related information for

supervisor

Consult with healthcare providers on diagnosis or risk assessment of patient

Perform complex maintenance procedures

Provides advisory services to technicians, technologists, and other specialists

Contact this candidate