cristian david sandoval calderon

I’m a detail-oriented Revenue Cycle Management (RCM) professional with 2+ years supporting U.S. healthcare operations across prior authorizations, accounts receivable, denial management, claims processing, and insurance verification. I focus on accuracy, speed, and workflow efficiency from payer response to final reimbursement.

In my current role as an AR Specialist (Accounts Receivable) at Health Prime, I manage denied claims resolution across multiple denial categories, review EOBs and payer responses to identify root causes, and complete actions like appeals, corrected claims, contractual adjustments, balance transfers, and reconsiderations. I communicate with insurance representatives, payer portals, and internal teams to keep follow-ups on track while maintaining HIPAA-compliant productivity and quality.

Previously as an RCM Authorization Specialist at Health Prime, I coordinated surgery prior authorizations by working directly with insurance companies, provider offices, patients, and payer portals. I verified eligibility and benefits, ensured required clinical documentation was submitted on time, and supported denial prevention and peer-to-peer review processes while working with CPT, ICD-10, and HCPCS codes.

Before moving deeper into healthcare revenue cycle, I worked as a Technical Support Agent (Voice & Chat) for the Concentrix / Google – Fitbit Account, delivering bilingual support and resolving technical issues with high satisfaction and first-contact resolution. That experience strengthened my problem-solving and communication skills—exactly what I bring to high-volume RCM work in fast-paced remote environments.