Brandi Stockton
Conifer Healthcare
White House,TN
18
years of professional experience
Detail-oriented compliance, audit, investigative, and data analysis professional with more than 18 years of experience analyzing complex data, conducting audits and investigations, interpreting regulatory and policy requirements, identifying discrepancies, evaluating business processes, and preparing detailed reports and documentation. Experienced in reviewing data for accuracy and completeness, researching regulatory requirements, conducting root-cause analysis, developing recommendations, and communicating findings to internal and external stakeholders. Strong background in regulated environments requiring independent judgment, confidentiality, documentation accuracy, and adherence to federal and state requirements.
Work History
Data Business Analyst
1 Year 3 Months- Analyze data accuracy, completeness, and reporting requirements to support regulatory compliance initiatives and ensure business processes meet established requirements.
- Research regulatory requirements and translate complex findings into reporting, technical, and system solutions.
- Develop and maintain detailed technical specifications, procedural documentation, business requirements, and supporting materials.
- Analyze complex business processes and data requirements to identify gaps, discrepancies, and opportunities for improvement.
- Create, prioritize, and manage user stories supporting Agile development and timely delivery of business and technical solutions.
- Collaborate with cross-functional teams and stakeholders to clarify requirements, resolve issues, and ensure accurate implementation of business processes.
- Provide guidance and support to end users regarding reporting functionality, data requirements, and business processes.
State Reporting Product Analyst
5 Years 1 Month- Researched and interpreted state reporting regulations and compliance requirements across multiple jurisdictions.
- Conducted audits and validation reviews to evaluate reporting accuracy, completeness, and compliance with applicable regulatory requirements.
- Investigated reporting discrepancies, identified root causes, documented findings, and coordinated corrective actions with clients and internal teams.
- Analyzed reporting data and metrics to identify trends, inconsistencies, and opportunities for process improvement.
- Designed technical specifications and business requirements based on regulatory and operational needs.
- Generated detailed reports and analyzed reporting metrics to support organizational decision-making.
- Developed training materials and provided instruction regarding regulatory reporting processes, system functionality, and compliance requirements.
- Led stakeholder meetings to assess reporting needs, resolve complex issues, and communicate findings and recommendations.
Senior Healthcare Economic Trend Analyst
4 Years 10 Months- Audited healthcare data and records to ensure compliance with program requirements and organizational standards.
- Gathered, reviewed, and analyzed data from multiple sources to assess program effectiveness and identify financial opportunities and discrepancies.
- Conducted complex investigations and root-cause analysis to identify and resolve data and process discrepancies.
- Analyzed financial and operational data to identify trends, evaluate outcomes, and support business recommendations.
- Forecasted revenue opportunities using data analysis and collaborated with analysts to improve and automate reporting and operational processes.
- Prepared detailed reports, test files, and analytical findings for clients and leadership.
- Presented complex analytical findings and recommendations to internal and external stakeholders and explained underlying system logic and methodology.
Program Integrity Analyst
9 Months- Conducted detailed investigations involving complaint reviews, data analysis, regulatory compliance, and supporting documentation.
- Utilized analytical techniques to identify billing irregularities, discrepancies, and potential fraud indicators.
- Requested, reviewed, and analyzed records and supporting documentation to evaluate compliance and substantiate findings.
- Prepared comprehensive investigative reports and supporting documentation for law enforcement agencies and regulatory partners.
- Maintained confidential records and documentation in accordance with federal security requirements.
Associate Program Integrity Analyst
1 Year 9 Months- Investigated and resolved beneficiary complaints involving regulated healthcare services.
- Requested and reviewed records and supporting documentation to validate billed services and investigate discrepancies.
- Conducted interviews with beneficiaries and providers and communicated regulatory and program requirements.
- Documented investigative activities and prepared reports involving suspected compliance violations and fraud allegations.
Pre-Pay Medical Review Team Lead
1 Year 6 Months- Supervised medical review staff, clinicians, and supervisors to ensure operational efficiency, accuracy, and compliance.
- Monitored workload, quality, accuracy, and timeliness metrics to identify trends and performance issues.
- Audited work products and provided coaching to improve compliance, accuracy, and performance.
- Developed and delivered training programs covering systems, policies, procedures, and work instructions.
- Maintained departmental documentation and procedural materials.
Pre-Pay Medical Review Senior Claims Analyst
3 Years 3 Months- Reviewed and analyzed medical claims to determine compliance with established guidelines, policies, and procedures.
- Made independent determinations requiring analytical judgment and interpretation of complex requirements.
- Maintained productivity and quality standards while managing individual workloads and competing priorities.
- Served as a subject matter expert and trained new staff on systems, procedures, and regulatory requirements.
- Assisted with quality assurance and process improvement initiatives.
Education
Bachelor of Arts - Criminal Justice
- In Progress
- Returning Adult Student | 18 credit hours remaining to complete bachelor's degree requirements
Associate of Arts - General Studies
Skills
Microsoft Excel
Word
PowerPoint
Data Analysis
Reporting & Metrics
Database Management
Data Validation
Quality Control
Jira
Agile Methodology
Technical Documentation
Business Requirements
Regulatory Research
Compliance Documentation
CORE COMPETENCIES
- Regulatory Compliance & Policy Interpretation
- Compliance Auditing & Quality Assurance
- Financial & Operational Data Analysis
- Investigations & Regulatory Research
- Data Validation & Reconciliation
- Discrepancy & Root-Cause Analysis
- Reporting & Metrics Analysis
- Regulatory Documentation
- Audit Findings & Recommendations
- Technical & Business Requirements
- Complex Spreadsheet & Database Analysis
- Process Improvement
- Risk & Compliance Assessment
- Records Management
- Stakeholder & Consumer Communication
- Microsoft Word, Excel & PowerPoint
- Agile Methodology & Jira
- Written & Verbal Communication
Timeline
Data Business Analyst
Conifer Healthcare
04.2025 - CurrentRead More
State Reporting Product Analyst
Qualifacts
03.2020 - 04.2025Read More
Senior Healthcare Economic Trend Analyst
Optum Healthcare
05.2015 - 03.2020Read More
Program Integrity Analyst
NCI AdvanceMed
08.2014 - 05.2015Read More
Associate Program Integrity Analyst
NCI AdvanceMed
11.2012 - 08.2014Read More
Pre-Pay Medical Review Team Lead
CGS Administrators (formerly Cigna Government Services)
05.2011 - 11.2012Read More
Pre-Pay Medical Review Senior Claims Analyst
CGS Administrators (formerly Cigna Government Services)
02.2008 - 05.2011Read More
Volunteer State Community College
Associate of Arts from General Studies
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Bachelor of Arts from Criminal Justice
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