Annie Perez
Miami,FL
Summary
Highly motivated and result oriented professional combing over 14 years of extensive experience in multiple facets of Health Care. Accomplished Credentialing Specialist with 10 years of experience accomplishing demanding information security related tasks. Maintains strict data accuracy, retention and access expectations according to internal productivity demands. Organized, thorough approach toward handling credentialing procedures and addressing requests-for-access. Tracked and compiled information management needs to ascertain access tiers.
Overview
21
21
years of professional experience
Work History
Credentialing Specialist
University of Miami
Miami
07.2014 - Current
- Responsibilities include but are not limited to: Process credentialing and re-credentialing applications and review supporting data
- Assist in the coordination of weekly credentialing meetings
- Collaborate with UMMG Clinical departments and administrative offices (Faculty Affairs, Risk Management, Legal Counsel, University hospitals and Managed Care)
- Obtain organizational Credentialing of Doctors, PA’s and other Health Care Givers
- Responsible for Organizational HIPPA Guidelines
- Confer with appropriate professional educational associations and personnel within and outside the University to promote knowledge/quality standards for the administrative management of healthcare professionals, which assumes compliance with practice standards, bylaws, State and Federal regulatory requirements, and meets the strict demands of Joint Commission and NCQA
- Assist with the Health Plan Audits and Joint Commission Audits
- Monitor License, DEA, Board Certification expiring dates to maintain updated
- Assist with the Temporary privileges and conduct primary source verifications
- Assist in App Central troubleshooting support such as resetting passwords, uploading documents for all physicians and allied health professionals
- Comply and agree to complete additional duties assigned to me by my Director and/or Manager and see the task through to timely completion
- Manage the completion and timely submission of provider applications
- Maintain open communication with Providers and provide continuous detailed updates on the status of their application
- Reviewed and processed credentialing applications to ensure accuracy, completeness, and compliance with all accreditation standards.
- Participated in periodic audits of credentialing files to maintain compliance with applicable regulations and policies.
- Conducted background checks on potential providers utilizing various resources including state licensing boards, OIG and GSA Exclusion List, NPDB.
- Coordinated with internal departments such as medical staff services or risk management to resolve any issues identified during the verification process.
- Assisted in developing and implementing departmental procedures related to provider enrollment and maintenance activities.
- Collaborated with internal teams regarding provider contracts and agreements.
- Provided support in responding to inquiries from external parties regarding credentialing information.
- Researched discrepancies between submitted provider data and verified sources when necessary.
- Attended meetings and seminars related to healthcare industry regulations and trends.
- Participated actively in special projects or initiatives pertaining to improvement of operational efficiency within the department.
- Addressed credentialing requests, overseeing compliance with governmental and organizational guidelines regarding tiered data access.
- Tagged documents according to tiered access thresholds, updating packets, reviewing reports and forwarding items requiring approval or verification.
- Sourced, qualified and conducted screening interviews with job candidates.
- Ensure timely completion of Applicant’s file to present to UMMG Committee for approval honoring Applicant’s pre-determined start date
- Assist with Fingerprinting
- Maintain organized and concise documentation pertaining to all Applicants.
Home Health Coordinator
Tender Touch Home Health
01.2008 - 05.2014
- Responsibilities include but are not limited to: Obtain organizational Credentialing and of Doctors, PA’s and other Health Care Givers for Tender Touch Home Health
- Coordinative and Organizational meetings, interactions audits and inspections that assured that AHCA, CMS and other Regulatory Guidelines and standards were followed and adhered to
- Responsible for Organizational HIPPA Guidelines
- Other responsibilities include: Manage the completion and timely submission of provider applications to governmental and commercial payers
- Payroll Preparation
- Intake: Receive Doctor's orders and schedule services for patients, follow up and confirm services and patient satisfaction.
- Coordinated with physicians, nurses, therapists, social workers, and other healthcare professionals to ensure timely delivery of quality care.
- Established communication with patients and families regarding the plan of care and provided education on disease process management.
Literature teacher for high school students
Champagnat Catholic School
08.2003 - 12.2007
- Responsibilities include but are not limited to: Grammar/Writing teacher for high school students
- Vocabulary teacher for middle school students
- Prepared and maintained weekly lesson plans
- Prepared objectives and outlines for courses of study and assisted in developing curriculum
- Prepared, administered and corrected tests for all grade levels
- Coordinated after school programs for students having difficulties (tutor)
- Assisted in grant writing
- Assisted in writing and developing a school code of conduct
- Member of School Improvement Plan Committee
- Yearbook Advisor
- Advised students entering college
- Counseled ESOL students throughout the year
- Implemented academic improvement plan for students with low GPA
- Acted as liaison between ESOL students and various colleges.
- Facilitated student understanding of complex literary concepts through interactive exercises.
- Used a variety of teaching methods such as lectures, presentations, readings, and multimedia resources.
- Evaluated student performance on tests and assignments to assess their progress.
- Maintained records of student attendance, grades, and other academic data for reporting purposes.
Education
Some College (No Degree) - Psychology
Barry University
Miami, FLSkills
- Proficient in: English and Written/Spoken Spanish
- Knowledgeable and of NCQA and Joint Commission Credentialing Standards
- Excellent written and communication skills
- Database Management Skills
- Ability to work independently and possess high attention to detail
- Take pride in my work and make all my tasks at hand a priority
- Ability to interact and communicate effectively and professionally with my coworkers, Directors, Managers, Providers and Department Personnel
- Proficient in Microsoft Word and Excel
- Proficient in App Central
- Proficient in Cactus
- Proficient in Genie
- Always willing and determined to learn new skills and put forth maximum effort in order to excel and move forward always with my department’s best interest at hand
- HIPAA Compliance
- Application coordination
- Excel, Cactus, OnBase expertise
- Application management
- Employee Onboarding
- Group Assistance
- Regulatory Compliance
Nickname
Annie Perez
References
Available and Professional Availble Upon Request
Languages
English
Native/ Bilingual
Spanish
Native/ Bilingual
Timeline
Credentialing Specialist
University of Miami
07.2014 - Current
Home Health Coordinator
Tender Touch Home Health
01.2008 - 05.2014
Literature teacher for high school students
Champagnat Catholic School
08.2003 - 12.2007
Some College (No Degree) - Psychology
Barry University