Kai Peña Email & Phone Number

San Diego, California, United States

San Diego, California, United States

Promoted to role with responsibility to conduct thorough market research and analysis of opportunities to improve commercialization of the pharmacogenomics program. Leveraged outcomes data to examine return on investment (ROI) potential for prospective clients, as a platform for expanding the program’s reach and profitability. Led implementation of new vendors, including the activation of QR codes, application programs (apps), and other strategies to improve the patient and healthcare provider experience. Identified the importance to create point-of-sale (POS) edits to facilitate claims adjudication associated with the program. The edits were developed to automate review of daily claims with specificity to identify new medications that were prescribed as a result of the genetic testing results. Measured impact of prescriber review and adherence to test results, documented prescribing changes, and reported findings in a quarterly outcomes report.

San Diego, Ca

Supported development of pharmacogenomics program from infancy as an innovative pilot to a successful specialty program that received recognition via the prestigious PBMI award for quality improvement for novel pharmacogenomics (PGx) solution. Awarded at 26th PBMI Annual National Conference.Participated in Agile sprints to facilitate onboarding of vendors through introduction of performance standards, metrics to be collected for measurements of processes and results, set-up for API connectivity, website creation, and specialized tools to increase operational efficiency, resulting in 58% improvement of member engagement process. Coordinated and executed day-to-day client implementation and overall operation of multi-phased pilot programs and product market tests. Created and managed databases and documentation using SQL and Oracle databases. Maintained detailedprogram statistics, metrics, and other key performance indicators, while regularly providing updates to program sponsors and clients. Designed and delivered monthly and quarterly client reporting.

Santee, California

● Processed up to 1,300 payments per day for HD Supply and sister companies● Scanned all mail via I-Tran● Performed QA on mail received to ensure accuracy -Performed mailroom duties

● Managed FS databases● Audited a total of 5,663 records● Audited medical/insurance/open enrollment records ● Studied/memorized Kaiser policies/procedures and guidelines ● Created multiple systems/processes/spreadsheets to assist team with organization and accuracy ● Created color coding systems to assist team with organization and accuracy ● Reviewed 10% of all open enrollments for accuracy ● Sent out errors found to AAR's to be corrected ● Stayed in contact with AAR's/AAR Managers to ensure errors were corrected in timely fashion ● Maintained and worked out of 4+ spreadsheets simultaneously ● Able to multitask and work on several items simultaneously ● Able to prioritize items and utilized excellent time management skills

Mcallen, Texas

● Thrived in a fast paced, stressful, environment ● Able to withstand 13 hour long shifts with minimal breaks ● Walked members through bank statements ● Answered any/all inquiries presented ● Memorized policies, procedures and rules for all Bank of America debit cards, ATM cards, checking/savings accounts, checks, statements, fees, travel flags, stop payments and different types of accounts presented from this bank● Educated members on rules, regulations and policies of Bank of America ● Consistently hit call center goals and metrics● De-escalated tensions with customers● Empathized with customers while still being able to stay firm● Addressed each call and customer with outstanding professionalism

Mcallen, Texas Area

● Created, audited, scanned and filed medical records in specified order ● Created invoices and input payments received ● Researched claim information and/or rejections on EOBs in order to follow through and have the claims processed promptly ● Billed with ICD-10/CPT Codes ● Tracked deductibles, co-insurance, co-payments, and insurance changes ● Processed medical records requests through mail and facsimile● Scheduled meetings and events for provider● Maintained checkbook, register, deposit, petty cash, checks and co-payments ● Conducted intake referrals as well as scheduling and sending reminders multiple times a day ● Secured and maintained insurance authorizations for each case ● Reviewed and submitted claims via mail, fax or electronically through various platforms. ● Prepared and performed sales adjustments and write offs to maintain accurate accounts receivable

Edinburg, Texas

Release of information for all of the South Texas Health SystemProcessed all SSA Disability requests for records● Created invoices for medical records requests and collected payments from patients ● Responded to telephonic inquiries as well as public inquiries and requests for release of medical information, status of requests, and/or general inquiries● Reviewed and approved records requests, measuring each against HIPAA criteria ● Prepared records and invoices for billing ● Established levels of priority for release turn-around times ● Prepared rejection letters and cover letters to be sent to requestors ● Entered and tracked requests by utilizing a computerized system● Utilized a computerized system to request original medical records ● Accessed and produced hard copies of imaged medical records on discs/hard drives

United States

Release of Information Specialist● Responded to public inquiries and requests for release of medical and dental information, status of requests and/or general inquiries. ● Reviewed each records request to make sure it was HIPAA compliant● Organized, packaged, mailed and tracked medical records ● Received and sorted mail and facsimile requests for release of information ● Entered and tracked requests by utilizing a computerized system ● Filed paperwork chronologically into physical records and delivered medical records throughout the medical training facility ● Participated in vigorous readiness training every 3rd Thursday of the month Medical Records Technician● Pulled and delivered medical and dental records ● Reviewed and purged medical and dental records ● Conducted audits on physical and electronic medical records ● Updated and tracked admissions and dispositions from MTF and local hospitals while notifying the appropriate personnel ● Pulled military orders and sorted the medical and dental records to be mailed out● Dropped off packages and worked with Military Post Office to ship out in orderly fashion● Filed paperwork manually and electronically and in-Processed medical and dental records ● Kept work place HIPAA compliant and ready to pass inspection at all times ● Continuously de-escalated disgruntled customers and patients ● Performed and directed patient management functions ● Interpreted communications, directives, and publications● Scheduled appointments, registered patients, and verified eligibility

Associate Of Science - As, Sociology

Health Services Management Technical Degree, Health Services Administration

Managed Care Pharmacy Certification, Clinical, Hospital, And Managed Care Pharmacy