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CertifyOS is building data infrastructure for modern healthcare, automating provider licensing, enrollment, credentialing, and network monitoring through an API-first platform that connects to hundreds of primary data sources.
The Director of Quality Operations leads a central quality function accountable for the accuracy of provider data, the work quality of credentialing files, and healthcare outcomes that depend on both. This is a hands-on operating role with direct accountability for daily audit throughput and turnaround time.
Key responsibilities include:
**Quality at Scale**: Define measurable quality standards (metrics, error taxonomies, baselines, targets) across data quality and work quality. Use data to identify error origins, high-risk clients and workflows, and prioritize fixes that remove the most defects at volume. Build a quality culture across Operations with clear standards, fast feedback, and accountability.
**Central Quality Team & Audit Engine**: Lead and grow a quality team conducting internal audits of credentialing files and processes. Iteratively improve audit methodology, sampling, scoring, error taxonomy, calibration, and reporting. Optimize audit coverage, consistency, and cost.
**Technology Integration**: Translate audit findings into root causes and drive product/automation changes (validation rules, workflow logic, primary-source integrations, system controls, AI-powered workflows). Work with Product, Engineering, and Data to specify, prioritize, and validate changes. Confirm through follow-up audits that error rates declined.
**Operational Performance**: Manage daily audit throughput and turnaround time through capacity planning, work allocation, and staffing. Run the team on data with dashboards, daily/weekly cadence, and clear escalation paths. Hire, develop, and maintain high performance standards.
**NCQA Compliance**: Own CertifyOS's NCQA certification end-to-end (readiness, evidence, survey prep, remediation). Interpret standards and translate into concrete, testable requirements. Monitor regulatory changes and ensure implementation in day-to-day workflows with clear ownership and effective dates. Verify post-implementation compliance in practice.
**Delegation Management**: Own the delegation program with health plan clients, including agreements, oversight schedules, and audits. Track delegated-function performance and lead corrective action plans.
**Requirements**:
- 10+ years in healthcare operations, quality, or compliance; 5+ years leading teams with direct ownership of throughput and turnaround-time targets
- Genuine obsession with quality in data, work, and outcomes; proven record of driving quality at scale with measurable before/after results
- Deep credentialing expertise: provider file building, verification, committee review, primary source verification, recredentialing cycles, common failure modes
- Strong data-driven approach: root cause analysis, sampling design, scoring, dashboard building, decision-making on numbers
- Experience running audit/QA functions at production scale (sampling, scoring, calibration, root cause analysis)
- Technical fluency to work with Product/Engineering: read workflows, write clear requirements, judge automation/system control feasibility
- Hands-on NCQA credentialing standards knowledge, ideally from leading/supporting certification or delegation audits
- Delegation experience (overseeing delegates at health plan or as delegated credentialing organization/CVO)
- Executive presence for health plan compliance officers and senior client leaders
- Strong written and verbal communication with good judgment on escalation
**Nice to Have**:
- Prior CVO, delegated health plan credentialing, or credentialing technology company experience
- NCQA experience beyond credentialing (provider network management, utilization management)
- Familiarity with URAC, The Joint Commission, CMS, state credentialing requirements, SOC 2, or HITRUST audits
- Data tools experience (SQL, BI dashboards, workflow analytics)
- Scaling startup experience with process building
