Quality Assurance Specialist – Credentialing

 

About the Role
Lyra is seeking a Quality Assurance Specialist – Credentialing who is passionate about building and maintaining a highly compliant, audit-ready credentialing program aligned with The Joint Commission (TJC) and NCQA standards. This role is critical in ensuring the integrity, accuracy, and compliance of provider credentialing files and processes across a nationwide network of mental health providers and group practices.

The Quality Assurance Specialist will lead credentialing file audits, oversee delegated credentialing functions (including CVO relationships), and support payer and accreditation audit readiness. This individual will play a key role in monitoring quality metrics, identifying compliance risks, and driving corrective actions to ensure adherence to regulatory and accreditation standards.

We are looking for a detail-oriented, compliance-driven professional who thrives in a highly regulated environment and is motivated to improve quality, strengthen audit performance, and support a best-in-class credentialing program.

●      Conduct comprehensive credentialing file audits and ongoing quality reviews to ensure compliance with TJC and NCQA standards.

●      Oversee delegated credentialing arrangements, including CVO performance, ensuring adherence to contractual, regulatory, and accreditation requirements.

●      Plan, coordinate, and execute payer credentialing audits, including managing audit documentation, responding to findings, and ensuring timely completion of corrective action plans.

●      Track, trend, and report credentialing quality metrics to internal committees, identifying risks, gaps, and opportunities for improvement.

●      Review, maintain, and update credentialing policies and standard operating procedures to ensure ongoing alignment with TJC, NCQA, and regulatory requirements.

●      Partner with credentialing and provider operations teams to remediate audit findings and implement sustainable process improvements.

●      Support accreditation readiness efforts by participating in TJC and NCQA surveys, including mock surveys and live accreditation reviews.

●      Assist in the collection, validation, and submission of required documentation and data for accreditation surveys and regulatory reviews.

●      Monitor credentialing processes to ensure ongoing compliance with internal policies and external regulatory standards.

●      Identify compliance risks, escalate issues appropriately, and recommend corrective and preventive actions.

●      Maintain audit-ready documentation and ensure alignment across credentialing systems, policies, and procedures.

●      Collaborate cross-functionally with Provider Success, Compliance, Legal, and Operations teams to ensure a consistent and compliant credentialing program.

●      Contribute to the development and refinement of credentialing QA policies, audit tools, and standard operating procedures.

●      Bachelor’s degree preferred (or equivalent work experience).

●      3+ years of credentialing, quality assurance, compliance, or healthcare operations experience, preferably in a behavioral health, hospital, or managed care setting.

●      Strong knowledge of The Joint Commission and NCQA credentialing and accreditation standards required.

●      Experience conducting credentialing audits, payer audits, and/or delegation oversight (including CVOs).

●      Demonstrated experience managing corrective action plans and driving compliance improvements.

●      Familiarity with accreditation survey processes, including 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, with the ability to clearly present findings, risks, and recommendations to stakeholders.

●      Experience with credentialing systems, audit tools, and platforms such as Salesforce, Jira, or similar systems preferred.

●      Strong organizational and project management skills, with the ability to manage multiple audits and deadlines simultaneously.

●      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.