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Quality Assurance Specialist – Credentialing

2 weeks ago
United States
Full-time
Mid Level
Manual QA Tester
Quality Assurance and Testing
JIRA Salesforce
Apply Now
Lyra Health

Lyra Health

Lyra Health is a global leader in mental health benefits, connecting companies and employees to world-class therapists and coaches. Their innovative platform offers fast, reliable access to evidence-based care for organizational well-being.

Health Care Providers & Services
1K-5K
Founded 2015
$627M raised
View All Jobs 39

Description

  • Conduct comprehensive credentialing file audits and ongoing quality reviews for compliance with TJC and NCQA standards.
  • Oversee delegated credentialing arrangements, including CVO performance and related contractual requirements.
  • Plan, coordinate, and execute payer credentialing audits, including documentation management and corrective action plans.
  • Track, trend, and report credentialing quality metrics to internal committees and stakeholders.
  • Review, maintain, and update credentialing policies and standard operating procedures.
  • Partner with credentialing and provider operations teams to remediate audit findings and improve processes.
  • Support accreditation readiness through participation in TJC and NCQA surveys, including mock surveys and live reviews.
  • Collect, validate, and submit required documentation and data for accreditation and regulatory reviews.
  • Monitor credentialing processes for ongoing compliance with internal policies and external standards.
  • Identify compliance risks, escalate issues, and recommend corrective and preventive actions.
  • Maintain audit-ready documentation across credentialing systems, policies, and procedures.
  • Collaborate cross-functionally with Provider Success, Compliance, Legal, and Operations teams.
  • Contribute to the development and refinement of credentialing QA policies, audit tools, and SOPs.

Requirements

  • Bachelor’s degree preferred, or equivalent work experience.
  • 3+ years of credentialing, quality assurance, compliance, or healthcare operations experience.
  • Experience in behavioral health, hospital, or managed care settings preferred.
  • Strong knowledge of The Joint Commission (TJC) and NCQA credentialing and accreditation standards.
  • Experience conducting credentialing audits, payer audits, and/or delegation oversight, including CVOs.
  • Demonstrated experience managing corrective action plans and compliance improvements.
  • Familiarity with accreditation survey processes, documentation preparation, and survey participation.
  • Strong analytical skills with the ability to track, interpret, and report quality metrics.
  • Exceptional attention to detail with a focus on accuracy, compliance, and audit readiness.
  • Excellent communication skills for presenting findings, risks, and recommendations to stakeholders.
  • Experience with credentialing systems and audit tools such as Salesforce, Jira, or similar platforms preferred.
  • Strong organizational and project management skills with the ability to manage multiple audits and deadlines.
  • Proactive, solutions-oriented mindset with the ability to identify gaps and drive continuous improvement.
  • Passion for advancing high-quality, compliant mental health care and supporting provider excellence.

Benefits

  • Base salary range of $61,000 to $76,000 per year.
  • Eligibility for discretionary bonuses.
  • Comprehensive healthcare coverage, including medical, dental, vision, FSA/HSA, life, and disability insurance.
  • Lyra coaching and therapy services for employees.
  • Equity in the company through discretionary restricted stock units.
  • Competitive time off policies, including vacation, sick days, and company holidays.
  • Paid parental leave.
  • 401(k) with up to 3% matching.
  • Monthly tech allowance.
  • Well-being perks, activities, surprise swag, and community celebrations.

Interested in this position?

Apply directly on the company website

Apply Now

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