Jeanette Gagnon
Wayne,PA
Summary
Revenue Cycle Specialist with extensive experience in resolving complex insurance denials and maximizing reimbursements. Recognized for improving billing accuracy and enhancing collaboration with providers and payers, resulting in significant revenue recovery. Proven track record in analyzing denial trends and implementing process improvements to reduce accounts receivable.
Overview
19
19
years of professional experience
Work History
Insurance Follow-Up Representative
Premier Orthopedics & Sports Medicine
01.2023 - Current
- Analyze and resolve complex insurance denials involving Medicare, Medicaid, and commercial insurance payers.
- Prepare comprehensive appeals that maximize reimbursement and improve claim recovery.
- Identify denial trends and recurring reimbursement issues, contributing to process improvements and increased revenue recovery.
- Recognized that rebilling corrected claims to obtain a current Explanation of Benefits created a pathway to successfully recover hundreds of high-dollar surgeries, custom durable medical equipment claims, and complex office visits that otherwise would have remained unpaid because of timely filing limitations.
- Partnered with corporate leadership to improve provider documentation, increasing reimbursement for durable medical equipment claims.
- Consistently maintain high productivity while working independently in a remote work environment.
- Resolve challenging accounts requiring advanced research, payer communication, and creative problem-solving.
- Collaborate with internal departments to improve billing accuracy and reduce future denials.
Insurance Follow-Up Specialist
MedScope America
01.2018 - 01.2023
- Managed insurance follow-up for more than ten payer organizations, including Anthem and Amerigroup.
- Directed large-scale reimbursement projects involving denial inventories exceeding 10,000 claims.
- Recovered approximately $200,000 in revenue per quarter through strategic denial management and reimbursement recovery.
- Built strong working relationships with nurse care managers, provider representatives, and internal sales teams to expedite authorizations and claim resolution.
- Developed collaborative workflows that streamlined Medicaid waiver authorization retrieval and claims reprocessing, significantly improving reimbursement efficiency.
- Led a year-long investigation into an exceptionally complex payer processing issue by coordinating with corporate leadership, program directors, payer representatives, and outside consultants until a successful resolution was achieved.
- Selected to manage the organization's most difficult reimbursement challenges because of strong analytical skills, persistence, and proven results.
Insurance Follow-Up Representative
Medical Data Management
01.2008 - 01.2018
- Performed insurance follow-up, appeals, charge entry, aging report analysis, and explanation of benefits review.
- Managed the company's largest client account and became the primary resource for complex reimbursement issues.
- Identified denial trends and implemented solutions that reduced outstanding accounts receivable.
- Resolved difficult claims that other representatives were unable to collect.
- Trained and mentored new employees on insurance follow-up procedures and denial resolution strategies.
- Recognized by leadership for exceptional productivity, analytical thinking, and problem-solving.
- Developed productive working relationships with insurance representatives to improve reimbursement outcomes.
Skills
- Revenue Cycle Management
- Claims management
- Denial analysis
- Appeals & Reconsiderations
- Authorization Management
- Medicare
- Medicaid
- Commercial Insurance
- Receivable reduction
- Revenue Recovery
- Process Improvement
- Trend analysis
- Provider & Payer Relations
- Billing Systems: Allscripts
- Billing Systems: Athena
- Insurance Portals: PEAR
- Insurance Portals: Availity
- Insurance Portals: Novitasphere
- Insurance Portals: UnitedHealthcare Provider Portal
- Software: Microsoft Excel
- Software: Microsoft Outlook
- Complex Problem Solving
Tagline
- Insurance Follow-Up
- Denials Appeals Revenue Recovery
Selected Career Achievements
- Recovered approximately $200,000 in revenue each quarter through strategic denial resolution and reimbursement recovery.
- Successfully managed denial inventories exceeding 10,000 claims across multiple Medicaid waiver programs.
- Developed innovative workflows that streamlined Medicaid authorization retrieval and accelerated large-scale claims reprocessing.
- Successfully resolved an exceptionally complex payer processing issue after nearly one year of investigation, persistence, and collaboration with corporate leadership and outside consultants.
- Earned a reputation throughout multiple organizations as the employee trusted to resolve the most difficult reimbursement challenges.
Timeline
Insurance Follow-Up Representative
Premier Orthopedics & Sports Medicine
01.2023 - Current
Insurance Follow-Up Specialist
MedScope America
01.2018 - 01.2023
Insurance Follow-Up Representative
Medical Data Management
01.2008 - 01.2018