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Kandis Gallagher

@kandisgallagher

Claims Analyst at Centene researching complex Medicare Advantage, Medicare, and Medicaid claims for accurate resolution.

United States

Message

At Centene, I review and research Medicare Advantage, Medicare, and Medicaid member claims, including complex cases involving coordination of benefits, member reimbursement, and payment discrepancies. I use claim history, eligibility, benefits, coding, and supporting documentation to determine accurate claim dispositions.

Previously, at RMJ Medical, I researched and resolved insurance claim issues, prepared appeals, and used payer portals such as Availity. I also processed approximately 70 prior authorization requests per day and hold a Certified Revenue Cycle Representative (CRCR) certification.

Experience

Work history, roles, and key accomplishments

Current

Claims Analyst

Current

Centene

Nov 2025 - Present (11 months)

Review and research Medicare Advantage, Medicare, and Medicaid member claims, including complex and non-standard claims. Manage claim processing queues and aging inventory, ensuring compliance with CMS timeliness requirements.

Medicare Claims Medicaid Claims Claims Adjudication Reimbursement Claims Appeals CMS Data Analysis Root Cause Analysis Process documentation Inventory Management Queue Management Excel

Claims Support Representative

Unum Group

May 2025 - Nov 2025 (6 months)

Reviewed incoming claim documentation for completeness and accuracy, managed high-volume electronic work queues, and researched incomplete or non-standard information. Documented claim actions and escalated exceptions as needed.

Claims Processing Documentation Queue Management Research Escalation Management Quality Assurance Privacy Compliance

Medical Billing Specialist

RMJ Medical

Aug 2016 - Dec 2021 (5 years 4 months)

Researched and resolved Medicare, Medicaid, and commercial insurance claim issues, including denials, appeals, and payment discrepancies. Managed high-volume claim and authorization queues and processed approximately 70 prior authorization requests per day.

Medical Billing Claims Resolution Prior Authorizations Appeals CMS 1500 UB 04 CPT HCPCS ICD 10 Availity Medicare Medicaid Root Cause Analysis Process documentation

Care Coordinator / Patient Access Coordinator

Fresenius Medical Care

Dec 2014 - Aug 2016 (1 year 8 months)

Verified insurance coverage and researched benefit requirements for dialysis patients. Coordinated authorizations and documentation to prevent treatment delays, while maintaining compliance with HIPAA and payer requirements.

Insurance Verification Benefits Survey Approval Coordination HIPAA compliance Electronic Health Records Patient Access Documentation