Michelle D'Agostino
Kirkville
Summary
Detail-oriented professional with extensive credentialing experience. Skilled in compliance verification and insurance navigation, contributing to streamlined processes and enhanced operational efficiency. Results-driven credentialing specialist with strong communication skills and a focus on team collaboration. Proven ability to manage provider relationships, ensuring timely completion of credentialing processes while maintaining meticulous records. Dedicated professional known for expertise in credentialing and surgical coordination. Committed to ensuring compliance and improving workflows, ready to leverage strong organizational skills to support healthcare operations. Knowledgeable credentialing specialist brings knack for performing successful application checks and verifying informational resources. Several years of experience overseeing data access and security based on up-to-date trends and standards. Adept at verifying primary sources and access-level tiers. Proven communicator and relationship builder expertly tracks complex update, certification and credential requests. Flexible and focused team player with expertise in customer relationship management, hr proficiencies, strategic planning and time management. Considered highly knowledgeable in information technology, systems and program management.
Overview
20
20
years of professional experience
Work History
Contract/Credentialing Specialist
Hematology-oncology Associates
East Syracuse
09.2020 - Current
- Verified provider credentials and gathered required documentation for compliance.
- Assisted in the preparation of credentialing files for review and approval.
- Managed communication with healthcare providers regarding credentialing status updates.
- Maintained organized records of provider credentials and relevant documentation.
- Collaborated with team members to streamline credentialing workflows and procedures.
- Supported data entry tasks into credentialing management systems efficiently.
- Responded to inquiries related to credentialing policies and procedures promptly.
- Ensured timely completion of credentialing processes by providing guidance to providers on required documentation.
- Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
- Processed re-credentialing applications for existing providers according to contractual requirements.
- Prepared correspondence for various departments concerning credentialing updates or requests for additional information.
- Maintained informational resources, tracking and documenting requests for updates, certification and credentialing.
- Checked applications for missing information and organized all paperwork.
- Maintained detailed records of provider data in the credentialing database system.
- Completed enrollments into Medicaid, Medicare and private insurance plans.
- Monitored expiration of licenses and certifications, notifying providers of renewal requirements.
- CAQH and Pecos updates
Authorization Specialist
Hematology and Oncology Associates
East Syracuse
09.2020 - Current
- clear understanding of medical insurance benefits, as well as, experience in obtaining medical insurance benefits, from the various insurance companies, including Medicare. Have in depth knowledge of the insurance industry preauthorization process, including what patient documentation is needed, to get an approval for the services. Understand the peer to peer/appeal process if the preauthorization is not approve.
- Experienced with working with patient’s insurance benefits, preauthorization’s, referrals, as well as, familiarity with navigating the insurance company websites. Excellent phone skills and organization. Skilled in identifying/investigating problems and arriving at a solution. Work well in a team oriented environment and is professional. Skill in computer applications is necessary. Ability to accept change
Surgical Coordinator
Dermatology Associates Of CNY
Fayetteville
08.2005 - 04.2020
- Coordinated surgical schedules to optimize operating room utilization and efficiency.
- Managed patient communication regarding surgical procedures and pre-operative instructions.
- Collaborated with surgeons, nurses, and administrative staff for seamless operations.
- Maintained accurate patient records and updated electronic health systems regularly.
- Trained new staff on scheduling processes and operational workflows effectively.
- Organized patient charts for surgical procedures and ensured accuracy of all documents.
- Answered phone calls from patients inquiring about upcoming scheduled surgeries or follow up visits.
Education
Associates Degree in Medical Assisting - Medical Assisting
Bryant And Stratton College
Syracuse, NY08-2004
High School Diploma -
Sandy Creek Central School
Sandy Creek, NY09-1993
Skills
- Credentialing management
- Compliance verification
- Insurance enrollment
- Medical documentation
- Electronic health records
- Provider relations
Timeline
Contract/Credentialing Specialist
Hematology-oncology Associates
09.2020 - Current
Authorization Specialist
Hematology and Oncology Associates
09.2020 - Current
Surgical Coordinator
Dermatology Associates Of CNY
08.2005 - 04.2020
Associates Degree in Medical Assisting - Medical Assisting
Bryant And Stratton College
High School Diploma -
Sandy Creek Central School