Open to opportunities

Nicole Edwards

@nicoleedwards

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Strategic credentialing and compliance professional with healthcare expertise.

United States

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What I'm looking for

I am seeking a role that allows me to leverage my compliance expertise while further developing my data analytics skills in a collaborative environment.

I am a strategic and detail-driven credentialing and compliance professional with a strong background in healthcare operations and regulatory standards. My experience includes reviewing and verifying healthcare provider credentials, maintaining a 99% accuracy rate while collaborating with cross-functional teams to uphold data integrity. I am known for my proactive problem-solving skills and my ability to engage stakeholders effectively.

Throughout my career, I have successfully managed credentialing workflows, conducted internal audits, and implemented corrective actions that reduced turnaround times by 15%. I am currently expanding my data analytics capabilities through advanced SQL training, which I believe will further strengthen my compliance strategy and operational reporting. My commitment to continuous professional development ensures that I remain at the forefront of industry standards and practices.

Experience

Work history, roles, and key accomplishments

Current

Credentialing Specialist

Current

Humana Government Business

May 2022 - Present (3 years 2 months)

Reviewed and verified 40–60 healthcare provider credentials daily against TRICARE and federal regulatory standards, maintaining 99% accuracy. Collaborated with cross-functional teams to uphold provider data integrity and support operational readiness.

Credentialing Regulatory Compliance Data Integrity

Credentialing Specialist / Quality Assurance Officer

Pathology Associates

Jan 2020 - Present (5 years 6 months)

Managed credentialing workflows across multiple facilities, ensuring regulatory compliance. Conducted internal audits, identifying process gaps and implementing corrective actions that reduced credentialing turnaround by 15%.

Credentialing Regulatory Compliance Internal Audit Process Improvement Quality Assurance

Data Control Clerk

Pathology Associates

Apr 2018 - Present (7 years 3 months)

Entered, verified, and maintained critical patient and specimen data in alignment with quality control protocols. Investigated and resolved data discrepancies, preventing compliance issues and preserving record integrity.

Data Entry Quality Control Data Integrity Documentation

Education

Degrees, certifications, and relevant coursework

Harvard University

Unknown, Data Analysis

Developing advanced proficiency in SQL for querying, organizing, and analyzing datasets. Coursework emphasizes real-world applications in compliance, operational oversight, and performance monitoring.