Kapihanaokealoha Pai
Operations Manager Rx
Summary
Reimbursement specialist with strong focus on achieving accurate and timely reimbursements in healthcare settings. Skilled in navigating complex billing systems, ensuring compliance with regulations, and fostering team collaboration. Reliable and adaptable, consistently delivering results in dynamic environments while maintaining high standards of professional conduct. Extensive experience in customer, patient, and client relations.
Overview
10
10
years of professional experience
Work History
Home Infusion Reimbursement Coordinator
Brightree
05.2024 - Current
- Ensured timely payments for clients through diligent monitoring and follow-up on outstanding claims.
- Increased staff productivity by providing ongoing training and support on relevant software systems and tools.
- Facilitated communication between patients, providers, and payers to resolve claim discrepancies and expedite payment processing.
- Maintained up-to-date knowledge of industry regulations, ensuring compliance with all applicable laws and guidelines.
- Reduced billing errors by implementing a thorough review process, resulting in increased efficiency and accuracy.
- Leveraged strong analytical skills to identify trends in payer behavior, enabling proactive adjustments to claims submission strategies when needed.
- Collaborated with cross-functional teams to develop strategies for maximizing revenue reimbursement opportunities.
- Enhanced reimbursement procedures by streamlining the claims submission process and reducing processing time.
Billing/Collections Representative
Jefferson Walnut Home Therapeutics
07.2023 - 05.2024
- Processed payments and contracts on accounts.
- Counseled debtors on payment options and arranged installment agreements.
- Improved collections efficiency by implementing strategic negotiation techniques and customer service skills.
- Proficiently navigated industry-specific software tools for efficient tracking, reporting, and analysis of collection efforts.
- Handled 25+ outbound and inbound calls daily with goal of collecting owed debt.
- Delivered exceptional customer service on collection calls and maintained calm and professional demeanor.
Operations Manager Rx
CVS Pharmacy
10.2021 - 10.2023
- Established positive and effective communication among unit staff and organization leadership, reducing miscommunications, and missed deadlines.
- Implemented business strategies, increasing revenue and effectively targeting new markets.
- Supervise, assign and direct activities of the store’s crew
- Effectively communicate information to store crew and supervisors in an open and timely manner
- Support Store Manager with actions plans for operational and service improvement
- Opened and closed location and monitored shift changes to uphold successful operations strategies and maximize business success.
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency, and service quality.
- Helped pharmacist clear problematic prescriptions and address customer questions to keep pharmacy efficient.
- Consulted with insurance company representatives to complete claims processing, resolve concerns, and reconcile payments.
Operations Supervisor Rx
CVS Pharmacy
04.2020 - 10.2021
- Improved customer satisfaction scores through application of superior conflict resolution and problem-solving skills.
- Analyzed department metrics and performance and reported findings to management.
- Resolved issues through active listening and open-ended questioning, escalating major problems to manager.
- Completed bi-weekly payroll for 15 employees.
- Evaluated team member performance and productivity, provided feedback and implemented corrective actions.
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency, and service quality.
Shift Supervisor Rx
CVS Pharmacy
03.2019 - 04.2020
- Volunteered for extra shifts during holidays and other busy periods to alleviate staffing shortages.
- Developed and nurtured lasting relationships with clients through dedicated assistance, issue resolution and active listening.
- Set and updated weekly work schedules to meet coverage demands by considering factors like expected customer levels, planned promotions and individual employee strengths.
- Examined incoming inventory, merchandised shelves and prevented shrinkage.
Store Associate Rx
CVS Pharmacy
07.2018 - 03.2019
- Briefed customers regarding shop promotions and discounts by providing coupons and flyers to increase sales.
- Delivered energetic responses to customers in-store and by telephone, going above and beyond to serve needs.
- Performed various pharmacy operational activities with strong commitment to accuracy, efficiency, and service quality.
Clerk/Cashier
CVS Pharmacy
11.2017 - 07.2018
- Greeted customers entering store and responded promptly to customer needs.
- Used POS system to enter orders, process payments and issue receipts.
- Worked flexible schedule and extra shifts to meet business needs.
- Stocked, tagged and displayed merchandise as required.
- Helped customers complete purchases, locate items, and join reward programs.
Paralegal
Pai Law, LLC
09.2015 - 01.2017
- Researched statutes, decisions, legal articles, and codes.
- Edited and proofread legal documents to verify accuracy.
- Communicated pertinent information to clients via phone, email, and mail.
Education
Bachelor of Arts - English Studies And A Minor in Legal Studies
University of Massachusetts Lowell
Lowell, MA08.2020
Legal Investigate Certificate Course -
Purdue University
West Lafayette, IN01.2016
Paralegal Certificate Course -
Hawai'i Community College
Hilo, HI10.2015
Languages
- English
Timeline
Home Infusion Reimbursement Coordinator
Brightree
05.2024 - Current
Billing/Collections Representative
Jefferson Walnut Home Therapeutics
07.2023 - 05.2024
Operations Manager Rx
CVS Pharmacy
10.2021 - 10.2023
Operations Supervisor Rx
CVS Pharmacy
04.2020 - 10.2021
Shift Supervisor Rx
CVS Pharmacy
03.2019 - 04.2020
Store Associate Rx
CVS Pharmacy
07.2018 - 03.2019
Clerk/Cashier
CVS Pharmacy
11.2017 - 07.2018
Paralegal
Pai Law, LLC
09.2015 - 01.2017
Bachelor of Arts - English Studies And A Minor in Legal Studies
University of Massachusetts Lowell
Legal Investigate Certificate Course -
Purdue University
Paralegal Certificate Course -
Hawai'i Community College