Director of Quality

CertifyOS

About The Position

The Director of Quality Operations is accountable for the quality of CertifyOS’s provider data, operational work, and the healthcare outcomes that depend on both. This leader will manage a central quality team that audits credentialing files and processes, uses audit findings and operational data to identify root causes, and improves workflows and technology to prevent errors. The role also owns CertifyOS’s NCQA compliance and delegation oversight, and serves as the senior compliance and credentialing voice with client stakeholders. This is an operating role with direct accountability for daily audit throughput and turnaround time. The Director will establish measurable quality standards and reporting, improve the audit program, translate findings into product and automation changes, and ensure that operational changes are implemented and followed. The role also leads the quality team’s staffing, development, and performance, and works closely with Product, Engineering, and Data.

Requirements

A demonstrated commitment to quality in data, work, and outcomes, with the judgment and credibility to assess whether work is correct.
A record of driving quality at scale by building measurement, audit, and feedback systems that improve error rates, with demonstrable results.
Strong data-driven skills, including root-cause analysis, sampling and scoring design, dashboard use, and evidence-based decision-making.
Deep credentialing expertise, including provider-file preparation, verification, committee review, primary source verification, recredentialing cycles, and common failure modes.
Experience running a production-scale audit or QA function, including sampling, scoring, calibration, and root-cause analysis.
Technical fluency to interpret workflows, write clear requirements, and assess automation and system controls with Product and Engineering teams.
10+ years of experience in healthcare operations, quality, or compliance, including 5+ years leading teams.
Direct ownership of operational throughput and turnaround-time targets.
Hands-on knowledge of NCQA credentialing standards and their audit process.
Experience leading or supporting an NCQA certification or delegation audit is ideal within the required NCQA experience.
Experience with delegation oversight from either the health plan side or as a delegated credentialing organization or CVO.
Executive presence and confidence presenting to health plan compliance officers and senior client leaders, including defending interpretations of standards.
Strong written and verbal communication and sound judgment about when to escalate issues.

Nice To Haves

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

Responsibilities

Own quality standards across provider data accuracy, completeness, and currency, and credentialing-file work quality.
Define and report measurable quality metrics, error taxonomies, baselines, and targets by client, workflow, and team.
Use data to identify error sources, high-risk clients and workflows, and improvements that reduce defects at scale.
Build a culture of quality across Operations through clear standards, rapid feedback, and accountability.
Lead and grow a central team that audits credentialing files and processes.
Improve audit sampling methodology, scoring, error taxonomy, calibration, reporting, coverage, consistency, and cost per audit.
Translate audit findings into root causes and work with Product, Engineering, and Data to specify, prioritize, and validate workflow, technology, integration, and automation improvements.
Confirm through follow-up audits that implemented changes reduce error rates, and determine when process, training, or policy changes are more appropriate than technology.
Manage daily audit throughput and turnaround time through capacity planning, work allocation, and staffing.
Run the quality team using dashboards, daily and weekly operating cadences, and clear escalation paths.
Hire, develop, and maintain high performance standards for auditors and team leads.
Own CertifyOS’s NCQA certification posture, including readiness, evidence, survey preparation, and remediation of findings.
Interpret NCQA standards and convert them into testable requirements for credentialing operations and the platform.
Monitor changes to NCQA standards, client requirements, and regulations; ensure changes are implemented through updated SOPs, training, checklists, and system configuration with assigned owners and effective dates.
Verify that new requirements are followed in practice after go-live.
Own health plan delegation programs, 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 through closure.
Present and advise as the senior quality and compliance representative to client stakeholders, including plan compliance and credentialing committee leaders.