Soledad Castillo Email & Phone Number

Los Angeles, California, United States

Responsible for the overall leadership, daily operations, strategic objectives, and financial management of Electronic Data Interchange, Encounters Data and Oversight, and Program Management departments.Overall responsibility and accountability for all aspects of the Claims Data & Support Services operation while effectively and efficiently delivering the claims data strategy across the Enterprise Shared Services organization.Development and execution on the strategic direction for the operation, leveraging experience and cross-functional collaboration to continuously improve claims and encounter data processes and procedures. Implementation of process improvements to enhance the efficiency of data processes and transform the way L.A. Care works with our medical groups, Plan Partners, DHS, and others relative to all data impacting Enterprise Shared Services business needs Worked closely with business leaders, analytics, and I.T. to develop dashboard reporting and Key Performance Indicators which are used to track performance towards established benchmarks, identify operational issues, and provide the necessary visibility to ensure data throughout the system is within control limits

Los Angeles, California, United States

Leadership of daily operations, strategic objectives, planning and implementation, resource and budget management, and development of business process and systems/technology capabilities (analysis, design, testing and problem/issue/risk resolution, and project management) for the Claims, Claims Compliance, Claims Quality Audit, Provider Dispute Resolution and Adjustments, Claims Research and Resolution, and the Enterprise 360 Quality Management departments, totaling 230+ staff

Los Angeles, California, United States

Led, mentored, and developed team of 5 Program Managers that were responsible for overall management and oversight of program and project execution for Claims, Encounters, EDI and select Utilization Management activities.Oversight of Provider Dispute and Resolution (PDR) and Adjustments team to ensure compliance with PDR acknowledgements and resolution timeframes as well as timely resolution of escalated cases.

Los Angeles, California, United States

Management of inter-departmental teams responsible for researching and resolving provider issues (P360 cases) related to claims payment accuracy, Remittance Advise discrepancies, missing checks, Provider Portal, Configuration, etc.Co-lead with Chief Operations Executive on 26 settlement negotiations, execution of agreements, settlement payments, and post- settlement activities.Led the P360 team and other key L.A. Care stakeholders in improving provider relationship management; shares best practices with stakeholders in cross-functional areas.Oversight of the development of project plans, (risk, communication, configuration and project work plans) that ensure full transparency of work done within the unit.

Los Angeles

Led, through cross-functional teams, the work performed within the project team to support the transition of business, functional/technical, and reporting requirements for Membership, Provider Network Operations, Claims, Finance, and Health Services to new core system. Oversight of the development of project plans, (risk, communication, configuration and project work plans) that ensure full transparency of work done within the unit.

Loa Angeles

Management and oversight of 40 cross-functional team members assigned to stabilize core claims and membership system and migrate 1M+Medi-Cal members