Ann-Sophie Juste
Columbia,MD
Summary
Strategic-thinking Provider Contracting Specialist with 10 years of experience building relationships, cultivating partnerships, retaining top accounts and growing profit channels by establishing trust. Persuasive and self-motivated with expertise in expanding network connections and introducing products. Well-versed in Medicaid, Medicare, Private Insurance, educating clients, implementing pricing strategies and driving territory development.
Overview
10
10
years of professional experience
Work History
Consultant
Aetna, a CVS Health - GA
02.2023 - 12.2023
- Participated in provider recruitment efforts during the medicaid RFP campaign in Georgia and Oklahoma
- Outreached to over 3500+ providers to collect required documents such as LOI, W9, ROS, if they intend to participate in CVS Medicaid network
- Utilize system's such as salesforces to create and manage provider contracts/agreement throughout the contracting lifecycle
- Configure provider data in Aetna database to feed into QNXT claim systems
- Participated in provider data clean up efforts post RFP campaign to maintain accuracy in Aetna's systems
- Well verse in contracting Medicare, Medicaid and commercial insurance
- Well versed in managing provider service agreements, hospital service agreements, as well as combined service agreements.
Underwriter - Provider Contracting
CareFirst BCBS - Baltimore, MD
06.2022 - 02.2023
- Managed the contracting and relations with medical facilities, including but not limited to: Hospitals, clinics, pharmacies and physicians
- Worked with Network Leads in performing service area analysis and cost analysis to identify network development and network renegotiation opportunities to meet affordability target
- Analyzed and determined in which regions and cities our network of providers must grow
- Negotiated and discussed agreements (direct payment agreements and/or discounts fees and price agreements)
- Ensures the correct handling of all administrative aspects of the agreements with the providers
- Maintains the Provider Data Base and make overviews of provider networks for all providers within the assigned region
- Analyzes price lists and data, write clear conclusions and identify cost containment opportunities.
Provider Contracting Lead Analyst
Cigna - Baltimore, MD
05.2020 - 04.2022
- Engage in high profile negotiations as required
- Assist Contractors with Charge Master, Rate Renewal, and Contract Amendment Submission as required
- Serve as project lead with conducting analysis to identify root causes and risk management
- Maintain a library of contracts and related documentation (program requirements, letters) etc
- Coordination and training of Contractors, Experience Managers, and other stakeholders on Cigna's System
- Conduct Contract Audit and review to ensure Market compliance
- Work closely with Cigna's Leadership team to ensure program documentation meets all Cigna requirements and state requirements, as necessary
Provider Relations Representative
Cigna - Baltimore, MD
10.2018 - 05.2020
- Developed and maintained strong relationships with providers by responding promptly to inquiries, resolving issues and providing ongoing support
- Investigated concerns such as billing,claims, and policy questions on behalf of providers
- Provided guidance on contract language, policy interpretation and reimbursement procedures to providers
- Performed regular audits of provider contracts to ensure accuracy of data in the system
- Participate and present in major health organization trade shows such as MD AAHAM and MDMGMA
- Manage a Book of Business of over 25 clients including major Health Systems and Large physician groups
- Boosted company productivity and customer satisfaction by streamlining or eliminating inefficient process.
Network Operations Specialist
Cigna Healthspring - Baltimore, MD
11.2016 - 10.2018
- Successfully engage and managed a book or business of 100 plus Physicians/Physician Groups in the Maryland and DC market
- Successfully contracted over 70% of my Book of Business in a Cigna Cost saving programs (i.e
- POD, IPA, ACE, P4Q)
- Participate in monthly financial review to present PODS, and Fee-for-Service provider's performance to leadership and respective matrix partners
- Conducted root cause analyses to formulate Corrective Action Plans for Physicians/Physician group not meeting performance expectations
- Identify Network Gap in care in order to appropriately contract new providers where needed
- Managed projects and served as primary liaison between client and multiple internal groups to clarify goals and meet standards and deadlines.
Director of Business Development
Autumn Lake Healthcare At Alice Manor - Baltimore, MD
07.2015 - 11.2016
- Optimized profitability by developing pipeline of prospects using multiple research, referral and sales strategies
- Managed the entire sales cycle process including prospecting, lead generation, qualifying prospects, presenting solutions, negotiating terms and closing deals
- Organized promotional events such as conferences, exhibitions, trade shows to reach out to target customers
- Created and managed a team of sales professionals to generate leads and close deals
- Analyzed market trends and identified new business opportunities in existing and potential markets.
Admissions Coordinator
Envoy of Pikesville - Pikesville, MD
05.2014 - 07.2015
- Managed patient admissions and discharge and referrals to other facilities, home health agencies and hospice based on resident and family needs, preferences and resources
- Performed health coverage verification i.e, Medicare and Medicaid coverage and private health insurance
- Developed and implemented strategies to improve the admissions process
- Maintained accurate records of admissions data and statistics
- Assisted with creating recruitment plans targeting potential patients.
Education
Master of Science - Health Information Technology
University of Maryland Global Campus
05.2019
Bachelor of Science - Gerontology
Towson University
Baltimore, MD05.2014
Skills
- Contract negotiation expertise
- Medicare, Medicaid, Private Insurance
- Market and competitive analysis
- Territory and account management
- Sales and market development
- Medicaid RFP Campaign
- National account management
- New Network Implementation
- Client Engagement
- Business Process Improvement
- Training and mentoring
- Microsoft, Word, Excel, Powerpoint, OneNote, Access
- Salesforce, Tableau, QNXT
Timeline
Consultant
Aetna, a CVS Health - GA
02.2023 - 12.2023
Underwriter - Provider Contracting
CareFirst BCBS - Baltimore, MD
06.2022 - 02.2023
Provider Contracting Lead Analyst
Cigna - Baltimore, MD
05.2020 - 04.2022
Provider Relations Representative
Cigna - Baltimore, MD
10.2018 - 05.2020
Network Operations Specialist
Cigna Healthspring - Baltimore, MD
11.2016 - 10.2018
Director of Business Development
Autumn Lake Healthcare At Alice Manor - Baltimore, MD
07.2015 - 11.2016
Admissions Coordinator
Envoy of Pikesville - Pikesville, MD
05.2014 - 07.2015
Master of Science - Health Information Technology
University of Maryland Global Campus
Bachelor of Science - Gerontology
Towson University
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