Dawn Corridore
Amsterdam,USA
Summary
Credentialing professional with proven track record in managing credentialing operations and ensuring compliance. Valued for strong collaborative skills and achieving results through efficient processes. Known for adaptability and reliability in dynamic environments, with expertise in documentation and regulatory standards.
Overview
23
23
years of professional experience
1
1
Certification
Work History
Credentialing Specialist
Frasier Enterprises (Miracle Ear)
06.2024 - Current
- Verify insurance carrier affiliation
- Prepare Hearing Aid Specialist for credentialing with third party company
- Prepare and maintain spreadsheets of store locations and Hearing Aid Specialists
- Follow up external third party credentialing
- Resignations
- Verification of staff annual Medicare Training
- Office duties as assigned
Medical Credentialing Specialist
Saratoga Hospital
04.2022 - 06.2025
- Managed provider reappointments across hospital and affiliate sites.
- Managed preparation of files for Credentials Committee assessment.
- Documented and organized minutes for each Credentials Committee Meeting.
- Tracked expiration dates of essential documents.
- Granted temporary access privileges to support patient care needs.
- Assigned privileges commensurate with experience.
- Oversaw resignation procedures.
- Conducted verification processes for compliance with state and federal regulations.
- Drafted and finalized Board approval letters.
- Verify Malpractice insurance and any affiliated claims
- Handled assigned administrative responsibilities.
- Coordinated timely responses to Joint Commission documentation inquiries.
Administrative Coordinator/Credentialing Specialist
Anesthesia Group of Albany, PC
04.2017 - 04.2022
- Facilitated credentialing process for new clinical staff with privileges and insurance carriers.
- Tracked completion of clinicians' Continuing Medical Education (CME) requirements.
- Coordinated meetings for Anesthesia Chiefs across 11 facilities.
- Oversaw calendar management for meetings involving 40 physicians.
- Managed scheduling for CRNA call shifts.
- Ensured timely renewal of certifications for 145 clinicians.
- Provided support to Billing Department during peak times.
- Managed recredentialing processes for 145 clinicians.
- Handled assigned office responsibilities.
- Managed CAQH updates efficiently.
- Proctor ACLS/BLS/PALS courses
- Answer telephone calls
- Prepared memos for clinical staff as directed by Chiefs.
- Tasked with managing Human Resource responsibilities, including open enrollment and addressing benefit issues.
Credentialing Specialist
MVP Healthcare
04.2016 - 03.2017
- Managed physician credentialing processes.
- Recredentialed current clinicians.
Medical Billing Specialist
Cardiology Associates of Schenectady
04.2015 - 04.2016
- Facilitated onboarding process for new physicians.
- Managed billing processes for healthcare services.
- Resolved payment discrepancies with insurance companies.
- Oversaw accounts receivable reports.
- Conducted coding for surgical cardiac procedures.
- Addressed inquiries related to patient billing.
Provider Credentialing Specialist
Blue Shield of Northeastern NY
04.2012 - 10.2014
- Facilitated credentialing process for new physicians across 49 counties in NY, PA, and VT.
- Coordinated initial credentialing requests for individual providers.
- Conducted direct follow-ups with providers.
- Generated CAQH accounts for provider database.
- Conducted thorough analysis to identify causes of incomplete files.
Workforce Planner
Blue Shield of Northeastern NY
01.2010 - 01.2012
- Focused on achieving first call resolution during telephone monitoring.
- Supplied detailed reports on call center metrics and analysis to supervisors, directors, and executive management regularly.
- Resolve intricate issues related to member enrollment, billing, claims, and benefits.
- Optimized call center operations through strategic scheduling and workload evaluation.
- Prepared detailed reports on perceived denials for Center for Medicare and Medicaid Services each month.
Technical Specialist
Blue Shield of Northeastern NY
01.2004 - 01.2010
- Gained expertise in overseeing customer service call center functions.
- Aided Call Center Supervisors by tracking agent performance.
- Executed simple, complex, and Medicare adjustments.
- Addressed and rectified discrepancies in pharmacy claims and Medicare Part D coverage.
- Monitored quality of telephone communications and correspondence.
- Managed and resolved complex calls related to member and provider issues.
- Processed referrals for system integration.
- Managed call center telephone systems, ensuring efficient handling of average speed of answer and queue management.
- Managed various healthcare plans including HMO, PPO, and EPO.
- Resolved complex issues related to member enrollment, billing, claims, and benefits.
- Facilitated training and logistics for client-related staff at Capital Blue Cross Blue Shield in Harrisburg, PA.
- Supported Capital Blue Cross Blue Shield representatives with questions and inquiries.
- Conducted testing during software upgrades and system conversions.
- Checked Annual Enrollment documents for correct data prior to Medicare and customer submission.
Medical Billing/Insurance Verification
Prime Care Physicians
01.2003 - 01.2004
- Medical Billing and follow-up
- Handled patient billing calls
- Filed records
Education
Business
Burnt Hills Ballston Lake High School
Burnt Hills06.1992
Skills
- HIPAA compliance
- Provider enrollment
- Credentialing oversight
- Regulatory compliance
- Employee onboarding
- Accreditation information management
- Credential verification
- Solo practitioner credentialing
- Facility credentialing
- Human resources support
Certification
Notary Public
Timeline
Credentialing Specialist
Frasier Enterprises (Miracle Ear)
06.2024 - Current
Medical Credentialing Specialist
Saratoga Hospital
04.2022 - 06.2025
Administrative Coordinator/Credentialing Specialist
Anesthesia Group of Albany, PC
04.2017 - 04.2022
Credentialing Specialist
MVP Healthcare
04.2016 - 03.2017
Medical Billing Specialist
Cardiology Associates of Schenectady
04.2015 - 04.2016
Provider Credentialing Specialist
Blue Shield of Northeastern NY
04.2012 - 10.2014
Workforce Planner
Blue Shield of Northeastern NY
01.2010 - 01.2012
Technical Specialist
Blue Shield of Northeastern NY
01.2004 - 01.2010
Medical Billing/Insurance Verification
Prime Care Physicians
01.2003 - 01.2004
Business
Burnt Hills Ballston Lake High School
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