Kristy Gao's work in San Francisco involves opening her laptop to a dashboard tracking thousands of medical referrals flowing through her startup's AI system. Just three years ago, she was writing code for carbon accounting engines at Watershed Climate. Today, as Co-founder of Cenote, she is tackling one of healthcare's most persistent inefficiencies: the fax machine.
The Fax Problem
The American healthcare system has a secret hiding in plain sight. Despite technological advances influencing every other industry, specialist clinics still receive hundreds of faxes weekly containing critical patient information. Each fax requires manual data extraction, insurance verification, and follow-up communication, a process so inefficient that 40 to 60 percent of patient referrals simply drop off, costing the U.S. healthcare system over $150 billion annually.
This administrative challenge became personal for Kristy Gao after a medical emergency left her reaching out for insurance claims and waiting six months for necessary follow-up care. The experience sparked the idea for Cenote, which she founded in 2024 with co-founders Kofi Ansong and Ajani Smith-Washington. They are friends she met through a book club she started to build connections in San Francisco.
"Leaving behind a job and a lifestyle that you've had for a few years, to start a company is scary," Kristy Gao explains. For her, the stakes were even higher due to immigration complications. "There's an additional complication where if I quit my job, I couldn't stay in the U.S. anymore because I didn't have a work visa. I actually moved back home to Canada for months."
What truly frightened her, however, was not the career risk or visa uncertainty, but "if I'd regret not trying."
From Waterloo to Y Combinator
Kristy Gao's technical foundation was built at the University of Waterloo, where she earned her Bachelor's in computer science in 2022. During her university years, she organized Hack the North, the world's biggest student hackathon, and founded the SoGal Chapter at Waterloo to reduce diversity gaps in entrepreneurship.
Her career accelerated through internships at Google, PayPal, and Cockroach Labs before landing at Watershed Climate, where she built carbon accounting engines. This expertise and healthcare experience helped her tackle the referral processing challenge.
In early 2025, Cenote was accepted into Y Combinator's Winter batch, securing $500,000 in seed funding and joining the ranks of an accelerator that launched industry giants like Airbnb and Reddit.
"It's a real privilege to be a recipient. YC can take any company to the next level, not just with their funding, but also their resources at hand, like their network and mentorship," Gao acknowledges.
AI-Powered Healthcare Administration
Cenote's platform automates the entire referral-to-treatment pipeline using a combination of artificial intelligence (AI), natural language processing (NLP), and robotic process automation. The system parses incoming faxes, identifies missing information, verifies insurance coverage, and integrates with electronic health records, reducing referral processing time from weeks to hours.
Since joining Y Combinator, Cenote's annual recurring revenue has surged with a 50 percent week-over-week growth rate. The startup now serves sleep clinics, durable medical equipment providers, and neurology practices, processing thousands of patients monthly.
Cenote's approach is unique because it focuses on building custom electronic health record integrations. "We're using AI browser automation to help build EHR integrations that traditionally take weeks," Kristy Gao explains.
The Future of Healthcare Administration
While Cenote focuses on the U.S. healthcare system, administrative inefficiencies plague medical systems worldwide. The World Health Organization estimates that 20 to 40 percent of all healthcare spending globally is wasted due to inefficiency, with administrative costs showing a significant portion of this waste. Countries with single-payer systems face different but related challenges. For example, the UK's National Health Service struggles with referral backlogs that have worsened since the COVID-19 pandemic, with waiting lists exceeding 7 million patients in 2023.
As Cenote develops, Gao plans to move into specialty pharmacies and wound care clinics. Cenote's approach suggests that the future of healthcare is not just about developing new cures, but about ensuring that existing treatments reach patients efficiently.
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