Director of Quality

About CertifyOS CertifyOS is building the data infrastructure that powers modern healthcare. Today, healthcare organizations rely on fragmented and outdated provider data. This creates unnecessary administrative work, regulatory risk, and higher costs across the system. We’re solving that problem. Our API-first platform automates provider licensing, enrollment, credentialing, and network monitoring by connecting directly to hundreds of primary data sources. We help healthcare organizations maintain accurate, compliant, and reliable provider networks at scale. Our vision is simple: One API. One provider ID. Frictionless provider data. We’re backed by leading investors and built by a team with deep experience in provider data systems. At CertifyOS, we value authenticity, accountability, collaboration, results, and openness to feedback. We’re building a high-ownership team focused on solving real infrastructure problems that impact millions of patients. ABOUT THE ROLE Quality is the job. The Director of Quality Operations is accountable for the quality of everything CertifyOS delivers: the accuracy of the provider data we build, the work our teams do to build it, and the healthcare outcomes that depend on both, from health plans trusting that every credentialed provider is verified to members reaching the right clinician. You will lead a central quality team that audits our own work every day, and you will use what it finds to raise quality at scale: measuring it, finding root causes, and changing workflows and technology so that errors are prevented rather than caught. We want someone who obsesses over quality and runs on data, and who does more than recognize what good looks like. You will know how to drive it, and you will have done so before. Alongside that, you will own CertifyOS's NCQA compliance and delegation oversight, and be the credentialing expert in front of senior client stakeholders. This is an operating role, so you will be accountable for the daily throughput and turnaround time of the audit engine. You will serve as the senior compliance and quality voice for CertifyOS with client stakeholders, including plan compliance, delegation oversight, and credentialing committee leaders. WHAT YOU'LL OWN QUALITY AT SCALE: DATA, WORK, AND OUTCOMES - Own quality as the standard for how CertifyOS works, across: data quality of what is surfaced to our clients (accurate, complete, current provider data), and work quality (credentialing files done right the first time) - Define what good looks like in measurable terms: quality metrics, error taxonomies, baselines, and targets by client, workflow, and team, reported to leadership and clients. - Drive quality up at scale. Use data to find where errors originate, which clients and workflows carry the most risk, and which fixes remove the most defects across volume. - Build a culture of quality across Operations: clear standards, fast feedback to teams, and accountability when quality slips. A CENTRAL QUALITY TEAM AND AUDIT ENGINE - Lead and grow a central quality team that conducts internal audits of credentialing files and processes. - Iteratively evaluate and improve the audit program: sampling methodology, scoring, error taxonomy, calibration, and reporting. - Improve the audit process itself, including coverage, consistency, and cost per audit. CLOSING THE LOOP INTO TECHNOLOGY - Turn audit findings into root causes and root causes into product and automation changes: 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. OPERATIONAL PERFORMANCE OF THE QUALITY FUNCTION - Manage daily audit throughput and turnaround time, with capacity planning, work allocation, and staffing to volume. - Run the team on data: dashboards, daily and weekly operating cadence, and clear escalation paths. - Hire, develop, and hold a high performance bar for auditors and team leads. NCQA COMPLIANCE - 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 our credentialing operations and platform. - Monitor changes to NCQA standards, client-specific requirements, and regulation. - Ensure each new requirement is implemented in the team's day-to-day workflow: SOP updates, training, checklists, and system configuration, with a clear owner and an effective date. - Verify after go-live that the change is being followed in practice, not just documented. DELEGATION MANAGEMENT AND OVERSIGHT - Own the delegation program with health plan clients: 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: you notice what is slightly off, you cannot leave it alone, and leaders and clients trust you to say whether the work is right. - A record of driving quality at scale. You have built the measurement, audit, and feedback systems that moved error rates in a high-volume operation, and you can show the before and after. - Strongly data-driven: you find root causes with data, design sampling and scoring, build and use dashboards, and make decisions on numbers rather than anecdotes. - Deep credentialing expertise: you know how a provider file is built, verified, and committee-reviewed, including primary source verification, recredentialing cycles, and the common failure modes in each. - 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: you can read a workflow, write a clear requirement, and judge 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: comfortable presenting to health plan compliance officers and senior client leaders, and holding your 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. Benefits of Working at Certify - At Certify, we’re building with intention and taking care of the people doing the work. - Your well-being matters to us. We provide 100% coverage of health, dental, and vision insurance premiums for employees. Our US-based team benefits from unlimited PTO, with at least two weeks off each year to recharge. In India, employees are supported with health insurance, statutory leave benefits, and additional wellness (menstrual) leave for women. We are an equal opportunity employer committed to building an inclusive environment where everyone feels valued and empowered to do their best work, and we welcome applicants from all backgrounds and experiences. If you require reasonable accommodations during the application process, please contact [email protected]. We are also committed to pay transparency and foster an open culture where compensation conversations are encouraged and respected.