Luis Pool Email & Phone Number

United States

San Antonio, Texas, United States

Assigned to CFHP to assist with configuration of latest changes and updates to the company’s claims and billing system via QNXT.

La Palma, California, United States

Telephonic outreach to ensure discharge plan is followed by recently discharged members from hospital or SNF.Document outcome in Essette system using TOC assessment tool for transitional days 12 and 20.Support and work along with TOC Case Managers assisting in making PCP/Specialist follow-up appointments, request, or fax over hospital notes/documents to providers’ office to facilitate UM, DME, and/or appointment.Disburse TOC daily discharge report amongst team via email.

Cerritos, California, United States

Answered and assisted with inbound calls from members regarding benefits information with their Anthem/Caremore Medicare Advantage Plans from the states of CA, AZ, NV, and VAAnalyzed problems, provided solutions from Caremore resources such as manuals, directives, MS intranetUtilized Facets, Compass, Client Console, Express Scripts, Caremore Portal, to efficiently assist members

Downey, Ca

Inbound and outbound calls for notification of members’ in-patient and/or emergency services with non-Kaiser facilities.Creates in-patient cases for case management for review and follow up and request clinical as neededReview and manage documents sent via Rightfax to include identifying pertinent documents which correspond with members stay at non-Kaiser facilities.

Long Beach, Ca

Assist with provider configuration using established program rules and data configuration to ensure proper claims adjudication and accuracy to health plan provider directoryUpdate provider, pay-to, and service location records to allow proper claims adjudication, provider demographics and practice demographics under the provider directory.Create new provider, pay-to, and service location records and create affiliations based on physical regions, medical program lines of business, and for claims adjudication

San Antonio, Texas Area

Assisted consumers with enrolling into the Affordable Care Act Marketplace insurances via internet, telephone, and/or paper formsProvided community outreach by educating consumers on qualifications to purchase insurance via the marketplaceAssisted consumers in remote locations throughout San Antonio, Texas and provided bilingual assistance in Spanish

San Antonio, Texas, United States

In-charge of managing obstetrics in-patient admits by following the member from their admission date to their discharge date and faxing an approval letter to corresponding hospital facilities if the member stays within allowable global periods.Request initial clinical (hospital care records) for nurse review once a member is admitted as an in-patient to a hospital facility within 4 hours of notification to SHP (Superior Health Plan).Maintain PHI (personal health information) integrity on any and all facsimiles and/or telephone communications with hospital facilities or medical offices.Calling and confirming the status of a pre-authorized, in-patient elective procedure to hospital facilities and then requesting clinical for nurse review.

Bachelor'S Degree, Business Administration

Associate Of Arts (A.A.), Business Administration