Summary
Overview
Work History
Education
Skills
Accomplishments
Languages
References
Timeline
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Diane Soto

Magna,Utah

Summary

Driven Director with a proactive attitude and the ability to thrive under pressure. Known for team leadership, high productivity and process improvement in both operations and revenue cycle. Specialized skills in operational improvement, adaptability and enhancement of team performance. Strong work ethic with exceptional interpersonal skills with desire to take on new challenges. Committed to improving customer satisfaction, delivering executive support and leadership to business operations.

Overview

28
28
years of professional experience

Work History

Director, Insurance Verification

Byram Healthcare
Salt Lake City, Utah
06.2014 - 10.2024
  • Directed the organization's daily operations, ensuring compliance with applicable laws and regulations.
  • Recruited, trained, supervised, evaluated and mentored staff members.
  • Identified opportunities for improvement in operational performance process.
  • Coordinated resources across departments to maximize cross training and performance improvement.
  • Assessed employee performance against established benchmarks or targets.
  • Facilitated collaboration between teams by encouraging open communication channels.
  • Implemented new proactive initiatives to streamline processes and enhance productivity.
  • Directed operations to improve efficiency and increase profit margins.
  • Promoted a culture of innovation and encouraged staff to contribute ideas.
  • Cultivated relationships with stakeholders to secure support and funding for Kaisen Events.
  • Prepared staff work schedules and assigned team members to specific duties.
  • Worked directly with the Revenue Cycle Vice President and payers to resolve underpayments and negotiate settlements.
  • Developed, implemented and lead the training with our outsourcing partners.

Appeals and Grievances Coordinator

Intermountain Healthcare
Ogden, UT
04.2006 - 04.2014
  • Resolved appeals through negotiations with insurance companies, attorneys, and other parties.
  • Compiled and documented information for appeal cases.
  • Maintained records of all appeal activities in a timely manner.
  • Reviewed denied claims for potential resubmission or reconsideration.
  • Responded promptly to all correspondence from third-party payers regarding patient claims.
  • Conducted research on billing regulations as needed to inform decision making.
  • Initiated contact with external agencies such as Medicare or Medicaid when necessary.

Billing Supervisor

Ogden Clinic
Ogden, UT
02.2004 - 04.2006
  • Supervised a team of 8 billing clerks to ensure accuracy and efficiency in daily tasks.
  • Conducted weekly meetings with staff to discuss performance metrics, goals, objectives, and other issues related to billing processes.
  • Resolved customer inquiries regarding invoice discrepancies or past due balances in a timely manner.
  • Provided training sessions on new software programs used for generating bills, tracking payments, and reconciling accounts receivables.
  • Negotiated terms of payments with customers when necessary while ensuring compliance with company policies.

Billing and Appeals Supervisor

PacifiCare of California
Cypress, CA
02.1997 - 06.2003
  • Supervised team of 15 employees in daily operations.
  • Tracked progress on projects and provided timely feedback to staff members.
  • Resolved customer complaints in a timely manner while ensuring customer satisfaction.
  • Recruited, hired, trained, mentored, coached, evaluated, and terminated staff as necessary.

Education

Bachelor of Science - Business Management

University of Phoenix
Salt Lake City, UT
08-2008

Skills

  • Hiring and retention
  • Process improvement
  • Decision-making
  • Employee development
  • Relationship building
  • Time management
  • Goal setting
  • Vendor relationship management
  • Performance management
  • Leadership development
  • Coaching and mentoring
  • Operations management
  • Task delegation
  • Negotiation
  • Business development
  • Project management

Accomplishments

  • Recipient of the "Vince Lombardi" MVP award in 2018
  • Personally congratulated and recognized by the CEO for my contributions to customer satisfaction in 2019 and 2020.

Languages

Spanish
Professional

References

References available upon request.

Timeline

Director, Insurance Verification

Byram Healthcare
06.2014 - 10.2024

Appeals and Grievances Coordinator

Intermountain Healthcare
04.2006 - 04.2014

Billing Supervisor

Ogden Clinic
02.2004 - 04.2006

Billing and Appeals Supervisor

PacifiCare of California
02.1997 - 06.2003

Bachelor of Science - Business Management

University of Phoenix

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Diane Soto