Cynthia (Cindy) Tonsfeldt
Ogden,IA
Summary
Effective Medical Claims Reviewer with strong background building rapport with claims associates and managers to discuss claim status or claim denials. Driven performer equipped to handle multiple administrative tasks effectively. Exemplary worker with highly investigative skills when processing claims and setting up a learning environment for the claims associates and managers.
Overview
71
71
years of professional experience
Work History
Medical Claims Consulting Specialist
Nationwide Insurance
Des Moines, Iowa
05.2014 - Current
- Managed large volume of medical claims on daily basis.
- Submit documentation with a medical opinion for review by claims associates, managers, directors, and AVP to enable them to determine how they will process the claim.
- Act as medical subject matter expert, answering internal questions and inquiries made by the claims associates and/or managers.
- Maintain strong knowledge of basic and advanced medical terminology to better understand services and procedures.
- Provided training materials to the claims associates and managers on the medical procedures. Presented Power Point presentations on the medical procedures. Invited outside guest to present topics of interest on medical procedures to the claims associates and managers.
- Provided my director with questions to ask for interviewing a new associate and made up a training schedule and materials for the new associate when she was hired.
- Research medical evidence for new procedures from scientific research studies to determine if a procedure had FDA approved or is considered by the scientific community as experimental/investigational
Child Birth Educator
Unity Point Des Moines
Des Moines, Iowas
03.1988 - 12.2017
- Set up and taught Power Point presentation for couples expecting twins or more to assist them in the birthing process.
- Attended community outreach presentations for pregnant couples
Medicare Medical Review Nurse
GCS
Des Moines, Iowa
05.2012 - 05.2014
- Reviewed Medical records for persons receiving Home Health and Hospice Care to determine if the providers were meeting the Medicare guidelines
- Denied Medicare claims when the guidelines were not being met
Medical Review Nurse
American Enterprise
Des Moines, Iowa
10.2000 - 02.2012
- Led the team of nurses doing medical records review for the Medical Insurance Carrier.
- Member of the team that set up the computer program for the new medical code auditing system.
- Expert in CTP, ICD-9, and HCFA codes and how they should be administered
- Researched and wrote Medical Policies for the company to use for the review of the medical records
Medicare Fraud Nurse
Blue Cross Shield Of North Dakota
Des Moines, Iowa
11.1999 - 10.2000
- Reviewed Medical records to assist the Medicare fraud investigators to determine if the providers appeared to be over billing or billing for services not rendered.
Labor and Delivery Registered Nurse
Unity Point Des Moines
Des Moines, Iowa
05.1980 - 11.1999
- Assisted obstetricians and midwives with deliveries and cared for newborns directly after birth.
- Coordinated care of low and high-risk laboring women of childbearing age and immediate stabilization of newborn following delivery.
- Supported physicians in both planned and emergency Cesarean section procedures.
- Aided with induction of labor for women suffering from complications such as preeclampsia.
- Responded to emergency situations such as pre-eclampsia, early labor and fetal distress.
Education
Bachelor of Science - Nursing
Chamberlan College of Nursing
Oakwood, IL05.2012
Diploma in Nursing - Nursing
Iowa Methodist School of Nursing
Des Moines, IA05.1980
Skills
- Insurance claims processing
- Knowledgeable in Claim Center and Nationwide Claims processing
- Medical terms and procedure knowledge
- Telephone etiquette
- Thorough claims reviews
- Health insurance industry knowledge
- Data security procedures
- Teaching with Power Point
- Medical documentation research to set up the teaching
Accomplishments
- Was a member of the Iowa Methodist Alumni Committee and as president was in charge of the annual banquet by getting guest speakers and setting the menus
- Found guest speakers on relative subject matter to present to the claims associates and mangers
- Performed the duties of Legal Nurse Consultant and testified at trial on the medical aspects of the claim
Affiliations
Legal Nurse Consultants of Iowa until 2005
Iowa Methodist Alumni Board until 2005
Timeline
Medical Claims Consulting Specialist
Nationwide Insurance
05.2014 - Current
Medicare Medical Review Nurse
GCS
05.2012 - 05.2014
Medical Review Nurse
American Enterprise
10.2000 - 02.2012
Medicare Fraud Nurse
Blue Cross Shield Of North Dakota
11.1999 - 10.2000
Child Birth Educator
Unity Point Des Moines
03.1988 - 12.2017
Labor and Delivery Registered Nurse
Unity Point Des Moines
05.1980 - 11.1999
Bachelor of Science - Nursing
Chamberlan College of Nursing
Diploma in Nursing - Nursing
Iowa Methodist School of Nursing
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