DeJuan Joyner

Detail-oriented Behavioral Health Credentialing Specialist with 10 years of dedicated experience managing provider enrollment, data compliance, and multi-state primary source verification. Proven track record of accelerating the onboarding pipeline for mental health professionals into major commercial insurance networks, including Aetna, Cigna/Evernorth, Anthem, and UnitedHealthcare/Optum. Adept at navigating CAQH ProView, NPPES, and PECOS portals while maintaining strict NCQA and HIPAA compliance. Committed to supporting clinicians through clear, empathetic communication to eliminate billing gaps and expand community access to affordable care.

• Managed provider credentialing and recredentialing workflows to keep enrollment files complete and accurate.
• Supported commercial provider enrollment for distributed behavioral health clinicians and cut credentialing turnaround time by.
• Completed primary source verification for incoming therapists and psychologists, confirming state licenses, education history, and malpractice records in line with NCQA standards.
• Updated and audited provider profiles for [number e.g. 150+] clinicians across CAQH ProView, NPPES (NPI), and internal systems, maintaining 100% data integrity for commercial insurance roster submissions.
• Tracked state license, CEU, and professional liability insurance renewals to help prevent interruptions to active billing status.
• Served as main point of contact for clinicians during onboarding, guiding compliance and payer paperwork with clear, supportive communication.
• Partnered with clinical onboarding, HR, and billing teams to support smooth transition from hire date to first insurance-reimbursable client session.

• Managed the onboarding process for new providers, ensuring the timely completion of all required documentation.
• Maintain rounding schedule for active providers
• Review Malpractice Insurance applications, tail coverage Monitor the NPDB, CMS, FSMB, DEA, MVR, NPI
• Manage providers in Acute Inpatient Rehabilitation Long Term Care and SNF Skilled Nursing Facilities
• Enhanced compliance with industry standards by conducting thorough audits of credential files.
• Collaborated with department leaders to develop policies and procedures for maintaining accurate provider records.
• Reduced processing times for credential applications by optimizing workflow efficiency and staff allocation.
• Assisted with preparing reports for senior management, highlighting key achievements and areas for improvement within the department.
• Facilitated smooth communication between departments, fostering collaboration and supporting credential management objectives.
• Established strong relationships with external agencies, streamlining communication regarding provider credentials and facility statuses.
• Coordinated closely with human resources to ensure seamless integration of hiring activities into the overall credentialing process.
• Led team meetings to discuss progress toward goals, troubleshoot issues, and share best practices among colleagues.
• Improved staffing during busy periods by creating employee schedules and monitoring call-outs.
• Conducted periodic risk assessments to identify potential vulnerabilities in credentialing workflows and implemented corrective measures as needed.

• 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.

• 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.

• 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.