Olga Barglowski
Palmetto,FL
Summary
Results-driven and detail-oriented Appeals & Recovery Team Lead with 3 years of experience leading a high-performing team and overseeing the appeals process. Demonstrated expertise in hospital billing, insurance denials, appeals, negotiating with health insurance companies, and ensuring the most favorable reimbursement for healthcare services provided. Strong knowledge of coding, medical billing, and insurance policies. Skilled in training, mentoring, and motivating team members while efficiently handling difficult cases and resolving disputes.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Appeals & Recovery Team Lead
Sarasota Memorial Hospital
03.2022 - Current
- Lead and manage team of 8 appeals and 2 recovery specialists, ensuring timely and accurate handling of claim’s denials and underpayments.
- Oversee the entire appeals process from the receipt of denial to the final determination ensuring compliance with current industry regulations and internal policies.
- Analyze data to identify denial trends and denials root causes.
- Participate in regular team meetings to provide updates and share best practices.
- Train new hires and provide ongoing support for team members.
- Participate in Joint Operating Committee meetings with various insurance companies.
- Communicate with various departments within the hospital regarding erroneous billing errors and coding denials.
- Review accounts to determine eligibility for Independent Dispute Resolution process and communicate with the out of network providers to negotiate payments.
Managed Care Analyst II
Sarasota Memorial Hospital
02.2018 - 03.2022
- Review and assign ownership of denials from a weekly report.
- Assign appropriate root causes of managed care denials.
- Investigate and work though complex insurance denials cases.
- Collaborate with cross-functional teams to resolve denials.
- Provide feedback and recommendation to improve appeals process.
- Act as a point of provider escalation for complex or trend issues denials.
- Key Achievements: Overturned 1227 accounts for the total reimbursement of $22,655,153.42
Managed Care Analyst
Sarasota Memorial Hospital
03.2016 - 01.2018
- Review and work insurance denials: untimely filing, billing, and coding errors, medical records requests, LCD and NCD denials, Medical Necessity, and level of care.
- Notify management regarding health insurance denial trends.
- Review medical policies and guidelines.
- Submit corrected claims.
- Write and submit appeal letters.
Medical Billing Specialist
Etrans Solutions
09.2013 - 03.2016
- Verify eligibility and obtain authorizations for surgical procedures and entering demographic and insurance data into the billing software.
- Post charges from the superbills, verify CCI edits for bundling issues, submit claims to the insurance companies electronically and on paper. Work and correct rejected claims.
- Post payments and reconcile with the deposit logs.
- Maintain positive relationships with various staff members of medical offices.
- Work AR regularly to maintain timely and accurate claims payments.
- Generate patients’ statements and respond to patients’ inquiries.
Education
BAS - Healthcare Administration
St. Petersburg College
01.2023
Associate Degree - General Health
St. Petersburg College
01.2021
Skills
- Knowledge of Microsoft Word, Excel, Access Anywhere, Hyland OnBase, SSI, PMMC, CPT/HCPCS coding guidelines, medical terminology, Interpersonal skills (Communication, Collaboration, working well in a team, respect) Fluent in Polish
Certification
- CPC-Certified Professional Coder (AAPC) 2019
- CPB-Certified Professional Biller (AAPC) 2015
- CRCS-I- Certified Revenue Cycle Specialist-Inpatient (AAHAM) 2023
Languages
Polish
Native or Bilingual
Timeline
Appeals & Recovery Team Lead
Sarasota Memorial Hospital
03.2022 - Current
Managed Care Analyst II
Sarasota Memorial Hospital
02.2018 - 03.2022
Managed Care Analyst
Sarasota Memorial Hospital
03.2016 - 01.2018
Medical Billing Specialist
Etrans Solutions
09.2013 - 03.2016
BAS - Healthcare Administration
St. Petersburg College
Associate Degree - General Health
St. Petersburg College