Nicole Cooper
Southfield
Summary
Healthcare operations and provider network professional with 19+ years of experience in provider enrollment, credentialing/recredentialing, and health plan administration across Medicare, Medicaid, and commercial lines of business. Expertise in NCQA standards, delegated credentialing support, provider onboarding, roster management, and regulatory compliance. Recognized for improving enrollment throughput, reducing credentialing turnaround time, and lowering denial rates through process optimization and data-driven reporting.
Overview
11
11
years of professional experience
Work History
Provider Enrollment Lead
Advantum Health
10.2020 - 10.2023
- Led end-to-end provider enrollment and recredentialing submissions across multiple health plans and payer portals.
- Processed an average of 45+ provider enrollments per week while maintaining accuracy and compliance standards.
- Reduced credentialing/enrollment turnaround time from 124 days to 90 days through workflow redesign and improved carrier follow-up cadence.
- Lowered credentialing-related denial rates by 75% through enhanced documentation quality, tracking, and escalation processes.
- Supervised and trained the enrollment team; standardized checklists and reporting to improve efficiency and timeliness.
Provider Network Account Executive I
AmeriHealth Caritas
10.2023 - Current
- Developed and managed provider relationships, ensuring compliance with contractual obligations and enhancing network performance.
- Analyzed provider data to identify trends, implementing strategies that improved access to care and service delivery.
- Collaborated with cross-functional teams to streamline operational processes, resulting in improved efficiency within the network.
- Monitored performance metrics and analyzed reports, leading to informed decision-making that positively impacted network operations.
Credentialing Manager
Beaumont Urgent Care (WellStreet)
05.2019 - 08.2020
- Directed credentialing and payer enrollment for 140+ providers across 15+ contracted health plans.
- Coordinated provider onboarding with Finance, HR, Marketing, and Operations to ensure timely provider go-lives.
- Implemented process improvements that enhanced credentialing efficiency and audit readiness.
- Partnered with IT to improve database functionality and reporting accuracy for provider data management.
Credentialing Coordinator
Trinity Health (HQ Michigan)
03.2015 - 05.2019
- Managed credentialing and recredentialing processes for physicians and advanced practice providers in compliance with NCQA standards.
- Maintained MSOW database records; supported audits through complete primary source verification and documentation.
- Developed training materials and supported staff training to enhance consistency, compliance, and turnaround performance.
Education
Master of Health Administration -
University of Phoenix
Bachelor of Science - Business Management
Cornerstone University
Skills
- Provider relationship management
- Provider data analysis
- Credentialing & Recredentialing
- Provider Network Management
- Provider Relations
- NCQA Standards
- Medicare/Medicaid Compliance
- Contract Compliance
- Process Improvement
- Network performance analysis
- Compliance monitoring
- Operational process streamlining
- Performance metrics analysis
- Provider enrollment management
Systems
CAQH, PECOS, NPPES, Availity, Symplr, Verisys, Cactus, Facets, Epic, Microsoft Excel, Access, Teams, Outlook
Timeline
Provider Network Account Executive I
AmeriHealth Caritas
10.2023 - Current
Provider Enrollment Lead
Advantum Health
10.2020 - 10.2023
Credentialing Manager
Beaumont Urgent Care (WellStreet)
05.2019 - 08.2020
Credentialing Coordinator
Trinity Health (HQ Michigan)
03.2015 - 05.2019
Master of Health Administration -
University of Phoenix
Bachelor of Science - Business Management
Cornerstone University