PROFESSIONAL PROFILE

Skilled and committed healthcare managed

markets and network contract leader with a

15+ year track record of proactively cultivating

relationships and a natural ability to solve

challenges and complex situations. Strong

knowledge of US healthcare economics,

including pricing, reimbursement, and the

changing healthcare landscape. Metrics driven,

working closely with Sales Operations and

analytics to understand and report on health of

networks. Excellent verbal and written

communication skills with the ability to

influence senior and C-level leaders. Advanced

listening and questioning capabilities that

leverage emotional intelligence to uncover

customer needs and pain points.

KEY SKILLS

Value Based Contracting and Negotiations

Contracts Administration

Project Management

Contract Compliance

Financial Planning

Commercial Product Portfolio

Cross-Functional Collaboration

Relationship Management

Competitive Intelligence

Set & Track Key Performance Indicators (KPIs)

Pricing Models

SAP

Tableau

Salesforce

Strategic Operations

Process Improvements

Risk Mitigation/Risk Management

Performance Management

Data Analytics

Benchmarking

CRM System

Regulatory Compliance

Microsoft Office Suite (Word, Excel,

PowerPoint, Outlook)

609-***-****

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EXPERIENCE

CVS/AETNA Woonsocket, RI/Remote 2021 – Present MANAGER, PROJECT MANAGEMENT – SALES/ACTIVITIY OPERATIONS Accountable for designing, planning, and negotiating high value contracts with the most complex and challenging groups and systems of spend providers in accordance with company standards to maintain and enhance provider networks. Partner cross-functionally to ensure consistency with all contracting strategies, meeting and exceeding accessibility, quality, compliance, regulatory and financial goals, and cost initiatives. Manage contract performance, and drive the development and implementation of value-based contract relationships in support of business strategies. Evaluate, formulate, and implement the vendor/provider network strategic plans to achieve contracting targets and manage medical costs through effective provider contracting to meet state contract and product requirements.

Key contributions:

• Responsible for developing, maintaining, and enhancing relations with local market teams and plan sponsors, providing updated communications of network changes in additional to preparing analysis’s that impact the network.

• Serve as a subject matter expert (SME) for network related inquires and assist with answering RFP questions for the sales team.

• Influence changes and enhancements to business processes, policies, and system infrastructure to improve quality, availability, and access.

• Evaluate project activities and build contingency plans to execute corrective action.

• Monitor issues to bring resolution and prepare statistical reporting to assist with contract negotiations to mitigate risk and avoid possible contract termination from the network.

CVS/AETNA BETTER HEALTH OF NEW JERSEY (MEDICAID) Princeton, NJ/Remote 2020 – 2021 NETWORK CONSULTANT, NETWORK MANAGEMENT

Negotiated, executed, and conducted high level review and analysis of dispute resolution and/or settlement negotiations of contracts with large and complex providers. Recruited providers as needed to ensure attainment of network expansion goals and achieve regulatory and/or internal adequacy targets. Initiated, coordinated, and owned the contracting activities to fulfillment, including receipt and processing of contracts and documentation and pre- and post-signature review of contracts and language modification according to established policies. Conducted research, analysis, and audits to identify issues and propose solutions to protect data, contract integrity, and performance. Key contributions:

• Managed operational needs with credentialing, contract interpretation, and Medicaid/Medicare/MLTSS services, contributing to maintaining and growing membership, and supporting operational needs, including database management and contract coordination.

• Conducted investigations, research, and review of escalated claim issues related to payment and system denials.

• Orchestrated offsite meetings with providers and office managers to educate providers and ensure compliance with contracts and policies.

• Resolved physician inquiries related to contracting, fee schedules, credentialing, and authorizations.

• Recruited non-participating physicians into network, negotiated approved fee schedules, and educated providers on company’s policies and procedures and claims guidelines.

S h a r o n L . H o p s o n, M P M

EDUCATION

Master of Project Management (MPM),

DeVry University, Keller Graduate School

of Management

Bachelor of Science in Business

Administration (BS),

Morgan State University

Professional Development:

Network Operations, Horizon Blue Cross

Blue Shield of New Jersey

Department of Treasury - Internal

Revenue Service, Taxpayer Service

Cigna Insurance Company, Property and

Casualty/ Umbrella/ LTD and STD Rating

Green Belt, GE Capital Mortgage Service

Corporation

GMAC Mortgage Company – Recruitment

and Sales –

Delaware Investments- Accountant,

Corporate Accounting

PROFESSIONAL

AFFILIATIONS

President Elect/ Scholarship Chairman,

Morgan State University Alumnae New

Jersey Chapter

The Links, Incorporated, Eastern Area

Nominating Chair (2023 – 2025)

The Links, Incorporated, Financial

Secretary South Jersey Chapter Recording

Secretary (2018 – 2022)

President, Alpha Kappa Alpha Sorority,

Incorporated – Theta Pi Omega Chapter

(2017 – 2020)

The Links, Incorporated, Financial

Secretary South Jersey Chapter (2012 –

2018)

Staff Parish Relations, Asbury United

Methodist Church (2000 – Present)

Usher Board President, Asbury United

Methodist Church (2016 – 2020)

Sharon L. Hopson, MPM Page 2

EXPERIENCE (cont’d)

UNITEDHEALTH GROUP, COMMUNITY PLAN (MEDICAID) Minneapolis, MN/Remote 2014 – 2019 PROVIDER RELATIONS ADVOCATE, NETWORK MANAGEMENT

Responsible for network development, network adequacy, and provider training and education, in alignment with the organization’s overall mission, core values, and strategic plan and in compliance with all relevant federal, state, and local regulations. Responsible for the daily operations of the department working collaboratively with other operational departments and functional business unit stakeholders to lead or support various Provider Network functions with an emphasis on contracting, education, outreach, and resolving provider inquiries. Oversaw appropriate and timely intervention and communication when providers had issues or complaints (e.g., problems with claims and encounter data, eligibility, reimbursement, and provider website). Key contributions:

• Managed the Home Community Based Service Provider Network, assisting Managed Long-term Services & Support within the State of New Jersey under UnitedHealthcare Community State Plan (Medicaid).

• Contributed to establishing a network and securing contracts within the state of Virginia, contracting ~350 providers.

• Increased the departmental Net Promoter Score by 20% due to adhering to customer inquiries timely measuring claim resolution and educational attainments.

• Provided essential claim resolution as well as education via investigation and analysis.

• Maintained external and internal relationships between the provider network and health plan, assisted the clinical staff with obtaining authorizations for services, and conducted investigations and risk assessments.

• Led and assigned special projects for team training, provider file and credentialing updates, and supported internal audits.

• Facilitated and completed state complaints within service level agreement arranged by the state of New Jersey Insurance Commission.

• Educated and trained the provider community via onsite workshops, conferences, and webinars, providing subject matter expertise on billing, contracting, credentialing, products, and authorizations.

• Developed training documents and ensured stakeholder review and approval for new hires.

UNITEDHEALTH GROUP Philadelphia, PA 2012 – 2014 NETWORK CONTRACT MANAGER, NETWORK MANAGEMENT

Key contributions:

• Managed accounts for healthcare professionals and physicians within Eastern Pennsylvania by resolving contracting and credentialing issues for all lines of business, including Commercial, Medicaid, and Medicare via site visits.

• Handled single case agreements.

• Increased UnitedHealthcare Group’s Network by contracting and recruiting new physicians and healthcare professionals in an underserved territory.

• Developed and administered fee schedules for payment.

• Maintained relationships while conducting contract negotiations securing business.

• Assisted with internal auditing and analysis for contracting. Previous position as Network Specialist at Horizon Blue Cross Blue Shield of New Jersey.

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