Ayesha Ghaffar
Rowland Heights
Summary
Results-driven professional with extensive experience at Hoag Health System, excelling in medical billing and collections. Proven ability in data analysis and compliance management, effectively resolving billing discrepancies and enhancing payment processes. Strong communication and analytical skills, consistently achieving productivity standards while maintaining patient confidentiality and regulatory compliance.
Overview
3
3
years of professional experience
1
1
Certification
Work History
DDR1 Analyst
C2C Innovative Solutions Inc
Remote
06.2025 - Current
- - Matched and verified data to determine whether disputes qualified under the Federal IDR (Independent Dispute Resolution) process.
- - Updated and maintained case records in the CMS portal to ensure compliance and accurate tracking.
- - Reviewed claims for timely filing, cooling-off periods, and possible objections prior to closure.
- - Processed claims for closures and escalated issues when necessary to support resolution efficiency.
Medical Collections Specialist
Hoag Health System
Costa Mesa
11.2024 - 05.2025
- Contact patients and insurance companies to resolve billing discrepancies and secure timely payments.
- Processed appeals and denials with patients medical records or requested documentation.
- Maintained compliance with HIPAA regulations while handling sensitive patient financial data.
- Analyzed aging reports and followed up on overdue accounts/claims over 30/60/90 plus days.
- Collaborate with billing, coding, and insurance departments to ensure clean claims submission and payment resolutions.
- Train new staff on collection procedures, insurance verification, and denial management.
- Processed an average of 35-50 accounts daily to meet department productivity standards.
- Worked on various projects based on different insurance payors or third parties.
- Familiar with vision insurance billing (VSP, EyeMed, Spectera, Davis Vision, etc.), including eligibility verification, prior authorisations, and claim submission.
- a proven
- Experience with the EPIC system for 3 years.
Medical Billing and Coding Specialist
California Kidney Specialist
San Dimas
11.2022 - 11.2024
- ICD-10 requirements & Data verification as CPT codes.
- Medical coding, abstracting, document management, and insurance billing for inpatients and outpatients.
- Reviewed periodic billing error reports and addressed, resolved, or reported unusual findings.
- Verified complete file information and documentation to substantiate code assignment.
- Analyzed claims data to verify assigned codes, signatures, and authorizations.
- Maintained accurate, up-to-date records of collection activity and communications with clients.
- Performed office processes related to billing, claims resolution, and account management.
- Monitored overdue accounts to determine which ones required additional action, such as legal proceedings.
- Experience with Raintree for 2 years.
Education
Bachelor of Science - Psychology
Mt Sac Antonio
Walnut, CA06-2026
Skills
- Customer service
- Communication skills
- Time management
- Computer literacy
- Microsoft Excel
- Microsoft word
- Microsoft Office
- Analytical thinking
- MS Excel
- Data research and validation
- Decision-making
- Data processing
- SQL and databases
- System analysis
- Evidence-based decision-making
- Claim processing
- Team collaboration
- Data analysis
- Medical billing
- Documentation management
- Compliance management
- Audit support
- Analytical problem solving
Certification
Mt Sac Antonio | Walnut, CA
- Medical billing and coding certification
- CPR Certification.
Languages
English
Full Professional
urdu
Native/ Bilingual
Punjabi
Native/ Bilingual
Hindi
Native/ Bilingual
Arabic
Elementary
References
References available upon request.
Timeline
DDR1 Analyst
C2C Innovative Solutions Inc
06.2025 - Current
Medical Collections Specialist
Hoag Health System
11.2024 - 05.2025
Medical Billing and Coding Specialist
California Kidney Specialist
11.2022 - 11.2024
Bachelor of Science - Psychology
Mt Sac Antonio