Dione Shypulski, CPCS

**** ****** ***., *** *** 651-***-****

St. Paul, MN 55119 admdmb@r.postjobfree.com

Objective:

To provide the organization with an excellent work ethic and quality skills that will provide the position for which I am hired. To continually seek new challenges to assist in my professional and personal growth.

Skills:

Cactus Outlook Word

Morrissey

Verity

Excel

Visio

PowerPoint

Flexible

ApplySmart Adobe Acrobat (Professional) Excellent Team Player Amysis Data Management Work without Supervision

Rumba Excellent Trainer Joint Commission

Streamline Organized NCQA

FoxTrot Proofreading MDH/CMS Standards

Macess/EXP InfoPath

Work History:

Ecumen (Contractor) April 2021 – Current

Credentialing Coordinator

• Create work instructions and applicable training documents

• Provide feedback to create and/or improve processes

• Follow up with payers, providers, clinic staff and leaders regarding enrollment status Midwest Dental (Contractor) November 2020 – February 2021 Credentialing Coordinator

• Create work instructions and applicable training documents

• Provide feedback to create and/or improve processes

• Primary Source Verifies applicable information

• Enroll providers with applicable payers in 17 different states using the payer/state credentialing applications

• Follow up with payers, providers, clinic staff and leaders regarding enrollment status

• Data entry of credentialing information into Verity (credentialing software)

• Work with clinic office staff to prevent/resolve issues related to provider set up

• Office TIN changes

Allina Health System March 2019 – June 2020

Credentialing/Provider Enrollment Specialist

• Create work instructions and applicable training documents

• Ensures providers credentials are up-to-date and accurate in Morrissey, which includes data entry of the Minnesota Uniform Credentialing Application

• Primary Source Verifies applicable information

• Enroll providers with applicable health plans

• Check MNITS for approval letters

• Answer ACD line and answer provider questions

• Follow up with health plans, providers, clinic staff and leaders regarding enrollment status MidWest Credentialing and Licensing Services August 2018 – November 2019 Credentialing Coordinator – Self Employed

• Create work instructions and applicable training documents

• Primary contact for applicable credentialing contracts

• Ensures provider credentials are up-to-date and accurate, includes data entry of the Minnesota Uniform Credentialing and Recredentialing Applications

• Requests (re)credentialing application and supporting documents

• Primary Source Verifies applicable information

• Enter provider’s information into the NetStudy2 website to obtain the date and location where a provider can complete the MN DHS Background Study, which also includes obtaining the approval letter

UCare August 2011 – June 2018

Credentialing Supervisor/Credentialing Specialist Senior/Credentialing Regulatory and Compliance Specialist

• Create and maintain policies, procedures, work instructions and applicable training documents

• Train, monitor and coach members of the credentialing team

• Train other UCare departments (staff) on the use of the credentialing software

• Audit staff’s data entry to ensure accuracy of date in the credentialing software

• Liaison for the Credentialing Department to ensure all documents are updated and adhere to National Committee for Quality Assurance (NCQA) standards and state/federal regulations

• Prepare documents for NCQA and MDH audit submission

• Review and process credentialing and recredentialing application, as needed to assist members of the credentialing team

• Review and process all red flags credentialing and recredentialing applications and work with the providers/credentialing contacts, and UCare’s Medical Directors accordingly

• Weekly prepare the credentialing and recredentialing clean file list for review and approval for the Medical Director

• Weekly update ApplySmart using Foxtrot for approved applicants

• Prepare Credentialing Committee packets, present committee materials and transcribe meeting minutes

• Manage routine monitoring of state board licensing actions, OIG exclusion, Opt Out list and complaints for practitioners

• Liaison to prevent/resolve issues related to provider set up for both internal and external customers

• Liaison for Cactus (credentialing software) support for all departments

• Conduct delegated pre-assessments and annual credentialing audits Blue Cross Blue Shield of MN (BCBS) July 2010 – July 2011 Credentialing Specialist

• Recredentialing files

• Data entry of credentialing information into Morrissey (credentialing software)

• Sent out recredentialing packets on a monthly basis

• Work with departments to prevent/resolve issues related to provider set up

• Manage the monthly sanctions from state boards

• Log and track ApplySmart applications

UCare 2009 – 2010

Data Analysts

• Ensured data is entered accurately and efficiently in the claims system

• Work with departments to prevent/resolve issues related to provider set up

• Work with departments in support of EDI and 62J submission UCare 2008 – 2009

Provider Demographic Supervisor

• Ensuring date is entered accurately and efficiently in the claims/billing system

• Data entry of delegated information into the credentialing software

• Create and maintain department policies, procedures, and provider manuals

• Work with departments to prevent/resolve issues related to provider set up

• Manage and set goals to improve/manage process improvement projects

• Provide feedback on staff performances

• Facilitate provider data set up meetings

• Work with departments in support of EDI and 62J submission

• Assist departments in implementing electronic forms (InfoPath) UCare 2001 – 2008

Senior Credentialing Specialist

• Ensuring provider credentials are up-to-date and accurate

• Data entry of delegated information in the credentialing software

• Monthly follow-up on overdue delegated practitioners

• Work with Medical Directors when applicable

• Investigating sanctions practitioners (state board actions, OIG and complaints)

• Developing reports

• Cactus software support

• Conduct delegated pre-assessments and annual credentialing audits

• Conduct internal audits on credentialing files

• Primary contact for credentialing delegation contracts

• Policy and procedure and process updates

• Participates in Employee Involvement Group

• Ensuring that information that is published in directories is current by auditing information

• Amysis data entry of newly credentialed and existing practitioners UCare 2000 – 2001

Administrative Assistant

• Supply ordering/On-line

• Billing

• Travel arrangements

• General office duties

• Minute taking

Carlson School of Management 1997 - 2000

Office Specialist

• Supply ordering/On-line

• Meeting/event planning

• Equipment maintenance

• Billing

• Research support – experiments

• Recruiting

• Textbook ordering

• Travel arrangements

• Seminar/workshop preparation

Ramsey County Opportunities Industrialization Center (RCOIC) 1997 - 1997 Work Study Student

• Answer multi-phone lines

• Filing

• Proofreading

• General office duties

Education:

U of M Course: Principles of Supervision 2015

Obtained certification as a Certified Provider Credentialing Specialist (CPCS) 2014 Facilitating Effective Meetings Workshop 2007

Project Management Training 2003

Business Writing Basics for Professionals 2002

Carlson School of Management 1999

EES Seminar Classes – Certificate in Administrative Staff Team Communication Human Resources in the Work Setting Organizing Time, Work and Priorities How to Work with Difficult People Verbal and Nonverbal Communication Skills Successfully Dealing with Conflict at Work

Management Skills for Administrative Staff

Ramsey County Opportunities Industrialization Center (RCOIC) 1996 – 1997 Certificate in Office Assistance/Receptionist

Professional Activities:

• Participated on a work group to assist with developing a Minnesota Universal Facility Credentialing Application

• Member of the Minnesota Association of Medical Staff Services (MAMSS)

• Participated in the MAMSS Education Committee

• Lead on the MAMSS Minnesota Uniform Credentialing Application Review (MUCAR) and Legislative Updates and Research (LUR) Committees

• Was a presenter at the Credentialing 101 Course (hosted by MAMSS)

• Volunteer at MAMSS conferences

• Previous member of the Minnesota Shared Delegation Oversight Collaborative

• Previous member of the Minnesota Uniform Credentialing Application Group

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