Director of Quality

Overview

Lead CertifyOS's quality function across provider data accuracy, credentialing work quality, and NCQA compliance and delegation oversight, and serve as the senior credentialing and compliance voice to client stakeholders.

What you'll do

• Own quality as the standard for how CertifyOS works, covering data quality of what is surfaced to clients and work quality of credentialing files.
• Define measurable quality standards, including quality metrics, error taxonomies, baselines, and targets by client, workflow, and team, reported to leadership and clients.
• Drive quality up at scale by using data to find where errors originate, which clients and workflows carry the most risk, and which fixes remove the most defects.
• Build a culture of quality across Operations with clear standards, fast feedback to teams, and accountability when quality slips.
• Lead and grow a central quality team that conducts internal audits of credentialing files and processes.
• Iteratively evaluate and improve the audit program, including sampling methodology, scoring, error taxonomy, calibration, and reporting.
• Improve the audit process itself, including coverage, consistency, and cost per audit.
• Turn audit findings into root causes and root causes into product and automation changes, including validation rules, workflow logic, primary-source integrations, system-enforced controls, and AI-powered workflow with human-in-the-loop.
• Work with Product, Engineering, and Data to specify, prioritize, and validate those changes, and confirm through follow-up audits that error rates fell.
• Use judgment about what technology can and cannot solve, and where the answer is process, training, or policy instead.
• Manage daily audit throughput and turnaround time, with capacity planning, work allocation, and staffing to volume.
• Run the team on data using dashboards, daily and weekly operating cadence, and clear escalation paths.
• Hire, develop, and hold a high performance bar for auditors and team leads.
• Own CertifyOS's NCQA certification posture end to end, including readiness, evidence, survey preparation, and remediation of findings.
• Interpret NCQA standards and translate them into concrete, testable requirements for credentialing operations and the platform.
• Monitor changes to NCQA standards, client-specific requirements, and regulation.
• Ensure each new requirement is implemented in day-to-day workflow through SOP updates, training, checklists, and system configuration, with a clear owner and effective date.
• Verify after go-live that changes are followed in practice, not just documented.
• Own the delegation program with health plan clients, including delegation agreements, oversight schedules, and annual and ad hoc delegation audits.
• Track delegated-function performance against client and NCQA expectations, and lead corrective action plans from finding through closure.

What you'll need

• A genuine obsession with quality in data, in work, and in outcomes.
• A record of driving quality at scale, having built measurement, audit, and feedback systems that moved error rates in a high-volume operation.
• Strongly data-driven, with experience finding root causes, designing sampling and scoring, and building and using dashboards.
• Deep credentialing expertise, including how a provider file is built, verified, and committee-reviewed, primary source verification, recredentialing cycles, and common failure modes.
• Experience running an audit or QA function at production scale, including sampling, scoring, calibration, and root cause analysis.
• Enough technical fluency to work with Product and Engineering, including reading a workflow, writing a clear requirement, and judging what automation or system controls can do.
• 10+ years in healthcare operations, quality, or compliance, including 5+ years leading teams, with direct ownership of throughput and turnaround-time targets.
• Hands-on knowledge of NCQA credentialing standards and how they are audited, ideally from having led or supported a certification or delegation audit.
• Experience with delegation from either side: overseeing delegates at a health plan, or being overseen as a delegated credentialing organization or CVO.
• Executive presence to present to health plan compliance officers and senior client leaders and hold ground on interpretation of a standard.
• Strong written and verbal communication, and the judgment to escalate the right issues early.

Nice to have

• Prior experience at a credentialing verification organization (CVO), a delegated health plan credentialing department, or a credentialing technology company.
• NCQA experience beyond credentialing, such as provider network management or utilization management standards.
• Familiarity with URAC, The Joint Commission, CMS, and state credentialing requirements, and with SOC 2 or HITRUST audits.
• Experience using data tools to monitor quality, such as SQL, BI dashboards, or workflow analytics.
• Experience in a scaling startup where processes were being built as the company grew.

Details

• Location: Remote US.
• Benefits include 100% coverage of health, dental, and vision insurance premiums and unlimited PTO with at least two weeks off each year for US-based employees.