LaShartey McGhee

Revenue Integrity Analyst at Ensemble Health Partners (2022-01 – Present)

Use Epic to analyze coding and billing regulation changes and implement updates to the Charge Description Master (CDM) and related charge capture processes.
Lead multidisciplinary collaboration to ensure accurate, compliant with payors guidelines, and optimized revenue cycle workflows across departments.
Develop and present quarterly and annual CPT/HCPCS and pricing updates, providing client education and change management support.
Leverage systems to identify revenue leakage opportunities and design process improvements that enhance net revenue integrity.
Conduct quarterly rounding with client revenue leaders to review charge reconciliation, process efficiency, and compliance outcomes.
Conducted continuous training on guidelines for insurance payors, ensuring accurate and timely claims processing.

Health Insurance Specialist at Provider Resources (IDRE) (2023-01 – Present)

Coordinate arbitration and CMS compliance projects, ensuring operational alignment with regulatory standards and revenue protection goals.
Collaborate with internal and external stakeholders to identify workflow inefficiencies and design corrective solutions.
Develop and standardize quality assurance procedures, increasing workflow accuracy and consistency by 20%.
Manage documentation, deliverables, and reporting to maintain transparency and accountability.

Lead Claims Research & Adjuster III, Payment Integrity at Humana Inc. (2016-11 – 2022-01)

Directed process-improvement initiatives in payment integrity to ensure timely and accurate claims resolution, including refund requests and payment processing.
Research claim data and account information to ensure accurate cash posting.
Designed and implemented training programs that improved compliance and reduced rework by 30%.
Refined SOPs and documentation to improve transparency and operational standardization.
Conducted data analysis to identify reimbursement trends and recommend corrective actions.

Authorization Specialist/Insurance Verification Specialist Supervisor at Froedtert & the Medical College of Wisconsin (2012-01 – 2016-11)

Led Epic workflow redesigns that reduced claim rejections by 82% and improved turnaround times.
Developed and delivered end-user training to improve system utilization and onboarding efficiency.
Facilitated insurance benefit verification and authorization request.
Supervised a team of financial counselors overseeing patient access and insurance verification workflows for 500+ weekly cases.
Collaborate with internal teams to collect medical records and complete chart review for accurate billing.

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