Kimberly Newenhouse

Office assistant III (12/01/1997 – 09/01/1998)

This position allowed me to learn my ICD9 and CPT codes for medical and hospital billing and payment.

Last Employer: Priority Health

Contact Person: 616 952 0954

Responsibilities: Sorted and scanned medical and hospital claims. Sent new member ID cards Sent letters to members explaining there coverage.

Accomplishments: I started here as a temp in December of 1997 and was hired in after a few months. I worked hard and was promoted to Claims Examiner in September of 1998.

Claims Examiner I (05/08/2000 – 01/01/2002)

Working as a claims Examiner I, ICD9 and CPT code skills were used to process and pay claims billed by medical offices and hospitals in and out of state.

Last Employer: Blue Care Network

Contact Person: 616 956 5700

Responsibilities: Correcting claims and sending payment out for claims billed by medical offices or hospitals that were billed incorrectly or have stopped in our system due to; lack of auth, non active member, copay issues providers office hold issues, member pay hold issues.

Accomplishments: I Learned how to read medical and hospital claims and how to pay and how they should be billed in order for correct payment to be made. Promotion to claims Examiner II.

Claims Examioner II (01/01/2002 – 01/01/2007)

Utilized complicated CPT and ICD9 codes. Learned how to work on difficult problems at a fast pace and still keep quality at or near 100%.

Last Employer: Blue Care Network

Contact Person: 616 956 5700

Responsibilities: Loaded priced and paid all pharmacy and member reimbursement clams. Worked on complicated claims that our system would stop for a number of billing reasons, or inside system issues, or member problems. Loaded and paid all claims that could not be directly scanned into the system for CPT code reasons or DRG hospital claims to long to scan needed to be handled by examiner could not be entered into system by data entry clerk. Processed DRG hospital claims and priced them for special payment.

Accomplishments: In this position I was able to learn the more complicated claim work and everything that needed to be fixed or done before a claim could be sent to a provider with payment. I Learned the pharmacy system and worked directly with Medco for member pharmacy reimbursements. Worked directly with Dr. Cook Blue Care Networks pharmacist to learn more about how pharmacy claims are authorized and why some drugs are not covered by insurance companies. Sent letters to member's explaining why these drugs are not covered. Worked on claims that members or providers filed a grievance fighting a reason why the claim was paid or denied the way it was.

Claims Liason Status Inquiry Unit (01/01/2007 – 12/17/2009)

This was the most rewarding position I have worked. I learned all the in and outs on how to bill, how auditing works, DRG facilities, specialized groups (University of Michiagn). In this position we fixed everything that came in on the back end that was incorrect when it was paid, priced or billed.

Last Employer: Blue Care Network

Contact Person: 616 956 5700/ Karen Mayberry

Responsibilities: Process and fix all the claims on the back end that came in from providers stating incorrect payment or no payment was made. Running town hall informational meetings to educate billers on the correct way to bill hospital and medical claim forms. Talked with providers to help fix problems they were having on claims, or the way they are being billed. Worked with the coordination of benefit (COB) department to fix claims that were billed, and multiple insurance companies are responsible for payment. Working all status inquiry claims for providers investigating and resolving all issues. Any claims problems providers had would come to our department for investigation and correction or explanation of why payment was not made. Worked on high dollar DRG claims. Worked on special interest groups such as the University of Michigan Hospital and group claims. (this group had its own payment and rules for payment of member's claims )

Accomplishments: I was able to expand my journey in the medical insurance and billing world. Several goals and production/quality standards were met. I would consider myself a semi expert on the billing/payment of medical insurance claims. I was awarded almost monthly for hitting production and quality goals set up by the company. I loved my job. I gave my notice to be able to be at home with my kids. The knowledge and understanding I learned from Blue care Network could never be learned in a college setting.

Establishment: Jenison High School

Degree: General

Education Period: 09/01/1993 - 05/01/1997

Speciality: Diploma

Average Grade: Senior

Details: High School