Quality Assurance Specialist – Credentialing

TL;DR

Quality Assurance Specialist – Credentialing (Healthcare): Building and maintaining a highly compliant, audit-ready credentialing program for mental health providers with an accent on TJC and NCQA standards. Focus on conducting file audits, overseeing delegated credentialing, monitoring quality metrics, and driving corrective actions for payer and accreditation readiness.

Location: Remote, USA

Salary: $61,000 - $76,000

Company

Leading provider of mental health solutions for employers, supporting over 20 million people globally through an AI-powered platform combining care and technology.

What you will do

• Conduct comprehensive credentialing file audits and quality reviews for TJC/NCQA compliance.
• Oversee delegated credentialing including CVO performance and contractual adherence.
• Plan and execute payer audits, manage documentation, and complete corrective action plans.
• Track, trend, and report quality metrics, identifying risks and improvement opportunities.
• Update policies, support accreditation surveys, and monitor processes for ongoing compliance.
• Collaborate cross-functionally to remediate findings and refine QA tools and procedures.

Requirements

• 3+ years in credentialing, QA, compliance, or healthcare operations, preferably behavioral health or managed care
• Strong knowledge of TJC and NCQA standards
• Experience with credentialing audits, payer audits, delegation oversight (CVOs)
• Managing corrective actions and accreditation survey processes
• Analytical skills for metrics, attention to detail, communication, project management
• Bachelor’s degree preferred or equivalent experience

Nice to have

• Experience with Salesforce, Jira, or similar credentialing systems

Culture & Benefits

• Comprehensive healthcare (medical, dental, vision, FSA/HSA, life/disability)
• Equity via RSUs, 401K with 3% match, paid parental leave, competitive PTO
• Lyra for Lyrians (coaching/therapy), monthly tech allowance, well-being perks
• Focus on joy-spreading activities, community celebrations, and work-life balance