Selinda Holley
Rocky Mount,NC
Summary
- Over 10 years of experience as a healthcare professional, with over 4 years as a Claims Support Representative.
- Experienced in Claims Processing, Denials, Appeals, Medical Billing, Explanation of Benefits and Insurance Verification, Prior Authorization and Referrals
- Knowledge of Medicare, Medicaid and Commercial Insurances
- Knowledge of Medical Codes (ICD-9, ICD-10, CPT Codes) and CMS100
- First AID & CPR certified, Medication Aide, CNA I, Seizure Management, Blood Borne Pathogens, NCI Training Medical Office Front Desk
- Excellent verbal and written communication skills
- Computer Knowledge: MS Office (Word, Excel, Outlook)
Overview
14
14
years of professional experience
1
1
Certification
Work History
Certified Medication Aide (CMA)/ Certified Nursing Assistant
Gale Healthcare Solutions
05.2023 - 10.2025
- Clean and bathe patients
- Assist use of the toilet & grooming
- Turn, reposition, and transfer between bed and wheelchair
- Adminster medication and records all medication given to Patients upon their specific charting
- Provide safety & privacy to each patients
Claims Processor-Remote
HealthcareSupport/Centene - Envolve Benefit Options
09.2021 - 07.2025
- Process pended medical claims, verifying and updating information on submitted claims and reviewing work processes to determine reimbursement eligibility
- Ensure payments and/or denials/appeals are made in accordance with company practices and procedures
Mental Health Technician (MHT)-PT
UNC NASH HEALTHCARE
02.2022 - 04.2024
- Complete physical checks and monitor patients to detect unusual or harmful behavior and report observations to professional staff
- Maintain patients' restrictions to assigned areas
- Work as part of a team that may include psychiatrists, psychologists, psychiatric nurses, or social workers
- Provide mentally impaired or emotionally disturbed patients with routine physical, care under the direction of nursing or medical staff
Referral Specialist I
Health Support/ Centene
04.2022 - 11.2022
- Answer phones, confirm appointments and address patient questions
- Process insurance authorizations and update patient records
- Provide customer service to walk-in patients, directing them to the appropriate area or resource
- Verify eligibility benefits
- Data entry of medical records and patient information
- Work EMR & AMR Discharging Patients
- Completed Fail Fax, Audit NABD Letters
Mental Health Technician (MHT)-PT
Medical Staffing Network
07.2011 - 03.2021
- Complete physical checks and monitor patients to detect unusual or harmful behavior and report observations to professional staff
- Maintain patients' restrictions to assigned areas
- Work as part of a team that may include psychiatrists, psychologists, psychiatric nurses, or social workers
- Provide mentally impaired or emotionally disturbed patients with routine physical, care under the direction of nursing or medical staff
Claims Support Representative
Builders Mutual
11.2016 - 01.2021
- Process first-Party claims by company policy and Applicable Federal and State Regulation
- Verifies coverage and damage reports received from vendors and customers for accuracy and consisted with the claim reported
- Examine EOB & Medical bills and provide Provider with valid data
- Communicate to obtain missing information for adjuster such as provider
- Review and log incoming bodily injury demands for tracking process
Customer Service
MetLife/Novitex
06.2014 - 08.2016
- Affix postage to packages or letters by hand, or stamp materials, using postage meters
- Place incoming or outgoing letters or packages into tray based on destination or type, and place identifying tags
- Arrival System to Receive & Delivery Packages
- Place incoming or outgoing letters or packages into sacks or bins based
Education
BBA - Healthcare Administration
University of Arizona Global Campus
San Diego, CA03-2026
Skills
- Information Validation
- Insurance Approval Processes
- Referrals
- Understanding of Medicare Programs
- Knowledge of Medicaid
- Knowledge of Commercial Insurances
- Familiarity with ICD-9, ICD-10, and CPT Codes
- CMS Proficiency
- CPR and First Aid Certified
- Medication Management Expertise
- Certified Nursing Assistant I
- Patient Seizure Intervention
- Bloodborne Pathogen Safety
- NCI Certification
- Claims Evaluation
- Denial Resolution Strategies
- Appeals Process Management
- Healthcare Billing Expertise
- Benefit Communication
- Insurance Eligibility Verification
- Strong Verbal Communication
- Proficient in MS Office Suite
- Document Evaluation
- Microsoft Office Proficiency
- Fast Typing Skills
- Client Support
- Professional Office Skills
- ICD Coding Proficiency
- Team Leadership
Certification
- RBT- Registered Behavior Technical
- CMA-Certified Medication Aide -Skilled Nursing Facility
- NCI-Nonviolent Crisis intervention
- CPR BLSR Certification
- CMA - Certified Medication Aide- Assisting Living Facility
- CNA - Certified Nursing Assistant
- EHR -Epic Electronic Health Records
Timeline
Certified Medication Aide (CMA)/ Certified Nursing Assistant
Gale Healthcare Solutions
05.2023 - 10.2025
Referral Specialist I
Health Support/ Centene
04.2022 - 11.2022
Mental Health Technician (MHT)-PT
UNC NASH HEALTHCARE
02.2022 - 04.2024
Claims Processor-Remote
HealthcareSupport/Centene - Envolve Benefit Options
09.2021 - 07.2025
Claims Support Representative
Builders Mutual
11.2016 - 01.2021
Customer Service
MetLife/Novitex
06.2014 - 08.2016
Mental Health Technician (MHT)-PT
Medical Staffing Network
07.2011 - 03.2021
BBA - Healthcare Administration
University of Arizona Global Campus