Kermit Rhodes Jr.
Sacramento,CA
Summary
Experienced healthcare administrative professional with over 7 years of expertise in patient eligibility, insurance verification, prior authorizations, and medical office operations. Strong knowledge of healthcare policies, ICD-10 and CPT coding, and patient financial processes. Proven ability to manage high-volume workflows, resolve insurance issues, and provide excellent patient service in fast-paced clinical environments. Committed to accuracy, compliance, and patient-centered care.
Overview
8
8
years of professional experience
Work History
Medical Office Representative
Dignity Health Medical Group (Pacific Staffing)
Sacramento, CA
01.2024 - Current
- Maintain accurate patient demographic and insurance information in EMR system
- Verify insurance eligibility, benefits, and coverage for new and returning patients
- Obtain and track prior authorizations for procedures and specialty services
- Manage referral processes to ensure timely patient care
- Explain patient financial responsibilities including copays, deductibles, and coinsurance
- Collect payments and resolve billing discrepancies and insurance denials
- Communicate directly with insurance carriers to clarify coverage and authorization requirements
Patient Eligibility & Authorizations Specialist
Sacramento Heart & Vascular Medical Associates
Sacramento, CA
01.2020 - 01.2024
- Verified insurance eligibility for new and established patients
- Updated and maintained patient insurance records in system
- Coordinated with patients and referring physicians to obtain accurate insurance details
- Conducted pre-visit reviews to ensure authorizations were secured prior to appointments
- Monitored daily schedules to identify add-on patients requiring authorization
- Ensured timely receipt of authorizations to prevent delays in care
Authorization Specialist
Hand Surgery Associates
Sacramento, CA
01.2019 - 01.2020
- Secured authorizations for MRI, CT scans, NCV/EMG, and other diagnostic procedures
- Verified insurance benefits and ensured accurate patient data entry
- Reviewed and processed prior authorization requests
- Collaborated with physicians and nurse case managers to support medical necessity documentation
- Assisted patients and providers with insurance-related inquiries
Eligibility Representative
Kelly Services (Contract)
Rancho Cordova, CA
01.2018 - 2018
- Processed eligibility updates for individual and employer-sponsored plans
- Entered new enrollments, changes, and terminations into system
- Researched subscriber accounts to resolve eligibility disputes
- Maintained departmental quality and productivity standards
Education
Associate of Arts - Liberal Arts
Contra Costa College
San Pablo, CA01-2007
Skills
- Patient Eligibility & Insurance Verification
- Patient Scheduling Experience
- Prior Authorizations & Referrals
- ICD-10 & CPT Code Knowledge
- Patient Financial Counseling
- Medical Terminology
- EMR Systems
- EPIC
- CERNER
- ATHENA
- Denial Management & Appeals
- Multi-line Phone Systems
- Microsoft Office Suite
- Strong Communication & Problem-Solving Skills
Timeline
Medical Office Representative
Dignity Health Medical Group (Pacific Staffing)
01.2024 - Current
Patient Eligibility & Authorizations Specialist
Sacramento Heart & Vascular Medical Associates
01.2020 - 01.2024
Authorization Specialist
Hand Surgery Associates
01.2019 - 01.2020
Eligibility Representative
Kelly Services (Contract)
01.2018 - 2018
Associate of Arts - Liberal Arts
Contra Costa College