DeJuan Joyner
Aurora,CO
Summary
With ten years of experience in the field of provider credentialing, my job is to keep track of providers' qualifications for credentialing and to maintain efficient communication with Provider Network Managers/Stakeholders. I also credential providers with regional commercial insurance network payers and government public programs like Medicare and Medicaid. Keeping track of insurance payer credentials and hospital contracts is a crucial responsibility of this function. Auditing and examining provider contracts and rosters and instructing providers on the necessary documents for credentialing in order to be taken into consideration as an active participating provider. Continued training with CAMSS/NAMSS
Overview
16
16
years of professional experience
Work History
Provider Credentialing
Denver Health Hospital
11.2020 - Current
- Perform daily Provider and Hospital credentialing for the FQHC Hospital primary point of contact for the Provider Credentialing Department, which employs over 2000 providers and medical students. While supervising and instructing employees in Provider Credentialing.
- Maintain credentialing applications and data maintenance.
- Review credentialing information electrically via shared computer files and CAQH.
- Perform follow -up with health plans in order to expedite participation approval by each health plan while maintaining communication with Provider Relation Representatives
- Perform tracking of all credentialing/re -credentialing time frames
- Monitor and review daily provider license,DEA, Board Certifications, NPPES,
- Enroll initial,affiliation,reassignments with government providers as a delegate/surrogate within online portals
- Create and maintain provider profiles on CAQH online portal
- Effective communication skills.
- Conducted primary source verifications such as background checks and board certifications.
- Received and evaluated applications to look for missing and inaccurate information.
- Enrolled providers and Medicaid, Medicare and private insurance plans. Colorado HCPF Medicaid and managed care and federal Medicare programs, including affiliations and reassignments.
- Obtained NPI numbers for providers and facilities and updated existing profiles.
- Advocated for staff members, helping to identify and resolve conflicts.
Insurance Patient Provider Retention,
DaVita
04.2018 - 11.2020
- Develop or expand and implement medical programs or health services that promote health insurance options for more informed coverage decisions. High level patient collaboration and education.
- Review and evaluate payer contracts, payor reimbursements and manage provider credentialing, NPI and enrollment. Enroll providers and revalidate Medicare and Medicaid and commercial insurances with continues monitoring while confirming and updating provider information using systems Capella, PECOS, NPPES.
- Consult with internal medical business partners to discuss patient assistance programs as well as coordinating with patients, document patient insurance choice and status, escalating issues and sharing best practices. Educating internal business partners on resources. Educate patients on cobra coordination of benefits throughout nation.
- Review insurance policy terms to determine whether a particular loss is covered by insurance. Strong relationship building with patients/internal partners.
- Locate and attach appropriate files to incoming correspondence requiring replies. Effective communication skills.
Lead Refund Analyst
Children's Hospital Colorado Anschutz Medical Campus
12.2007 - 04.2018
- Prepare detailed reports on audit findings
- Report to management on audit results and recommend changes in operations financial activity
- Review, adjust and edit insurance coverage for Medicaid/Medicare and commercial insurances, bills and statements to ensure accuracy
- Analyze all patient accounts, dispersing refunds to patients, insurance companies or charity organizations
- Review contact matrix to calculate reimbursement
- Continual follow-up on business operations by executing modifications with either patient or colleague education for best practices.
Education
Bachelor of Science - Psychology
Regis University
Denver, CO10.2023
High School Diploma -
South High School
Denver, CO06.1993
Skills
- EPIC/Stockamp/Meditech Expert
- MDstaff
- CAQH
- Medicare/Medicaid Proficient in over 10 states
- Strong Leadership/Excellent Customer Service
- Expert MS Office
- Accountable/Results Driven
- Excellent Communication Skills
- Expert Finance and Accounting
- Credentialing Oversight
Timeline
Provider Credentialing
Denver Health Hospital
11.2020 - Current
Insurance Patient Provider Retention,
DaVita
04.2018 - 11.2020
Lead Refund Analyst
Children's Hospital Colorado Anschutz Medical Campus
12.2007 - 04.2018
Bachelor of Science - Psychology
Regis University
High School Diploma -
South High School
Similar Profiles
Askal WoldekidanAskal Woldekidan
LPN at Denver Health HospitalLPN at Denver Health Hospital
Degnesh RiskeDegnesh Riske
Registered Nurse at Denver Health HospitalRegistered Nurse at Denver Health Hospital
Zineb AbadZineb Abad
Sterile Processing Technician at Denver Health HospitalSterile Processing Technician at Denver Health Hospital