Director of Quality

This is a fully remote position, open to applicants in United States.

📋 Description

• Take ownership of quality standards related to provider data integrity and the quality of credentialing work.

• Establish quality metrics, error classifications, baselines, and targets tailored to clients, workflows, and teams.

• Present quality metrics to leadership and clients.

• Detect sources of errors, identify high-risk clients and workflows, and pinpoint significant remediation opportunities.

• Foster a culture of quality within Operations through established standards, constructive feedback, and accountability.

• Lead and develop a central quality team tasked with conducting internal audits of credentialing files and processes.

• Enhance audit sampling techniques, scoring systems, error classifications, calibration processes, reporting, coverage, consistency, and audit cost efficiency.

• Convert audit results into root cause analyses and propose product or automation enhancements.

• Work in collaboration with Product, Engineering, and Data teams on requirements gathering, prioritization, validation, and follow-up audits.

• Oversee daily audit throughput and turnaround times via effective capacity planning, task allocation, and staffing strategies.

• Manage dashboards, daily and weekly operational rhythms, and escalation pathways.

• Recruit, develop, and uphold a high-performance standard for auditors and team leaders.

• Oversee CertifyOS's NCQA certification status, including readiness, evidence collection, survey preparation, and remediation efforts.

• Interpret NCQA standards and convert them into actionable requirements for credentialing operations and the platform.

• Keep track of NCQA standards, client-specific requirements, and regulatory updates.

• Implement new requirements through updates to Standard Operating Procedures (SOPs), training, checklists, and system configurations.

• Confirm adherence to practices post-launch.

• Manage delegation programs with health plan clients, including agreements, oversight schedules, and delegation audits.

• Monitor performance of delegated functions and lead corrective action plans to resolution.

• Act as the senior compliance and quality representative with client stakeholders and leaders of credentialing committees.

⛳️ Requirements

• A strong passion for quality in data, processes, and outcomes.

• Proven track record in enhancing quality at scale through the development of measurement, auditing, and feedback systems that lower error rates.

• Highly data-oriented; capable of identifying root causes using data, designing sampling and scoring methods, creating and utilizing dashboards, and making data-driven decisions.

• Extensive credentialing knowledge, encompassing provider file creation, verification, committee reviews, primary source verification, recredentialing cycles, and common pitfalls.

• Experience managing an audit or quality assurance function at production scale, including sampling, scoring, calibration, and root cause analysis.

• Sufficient technical proficiency to analyze workflows, articulate clear requirements, and assess automation and system controls.

• Over 10 years of experience in healthcare operations, quality assurance, or compliance.

• At least 5 years of experience in team leadership with direct accountability for throughput and turnaround-time objectives.

• Practical knowledge of NCQA credentialing standards and their auditing processes.

• Familiarity with delegation, whether overseeing delegates at a health plan or being managed as a delegated credentialing organization or Credentialing Verification Organization (CVO).

• Executive presence when engaging with health plan compliance officers and senior client executives.

• Excellent written and verbal communication skills.

• Sound judgment to promptly escalate relevant issues.

• Preferred: experience in a CVO, delegated health plan credentialing department, or credentialing technology firm.

• Preferred: NCQA experience beyond credentialing.

• Preferred: familiarity with URAC, The Joint Commission, CMS, state credentialing regulations, SOC 2, or HITRUST audits.

• Preferred: experience with SQL, BI dashboards, or workflow analytics.

• Preferred: experience in a growing startup environment.

🏝️ Benefits

• Full coverage of health, dental, and vision insurance premiums for employees.

• Unlimited paid time off for US-based team members, with a minimum of two weeks off each year to rejuvenate.

• Health insurance coverage for employees in India.

• Statutory leave benefits for employees in India.

• Additional wellness leave (menstrual) for women in India.

• Commitment to equal employment opportunities and an inclusive workplace.

• Reasonable accommodations provided during the application process.