This role serves as the governance owner for order quality controls, process audit routines, quality assurance standards, scorecard metrics, and continuous improvement recommendations. The position partners closely with Training, Compliance, Order Management leaders, Revenue Integrity, Billing, Sales Support, and other cross-functional teams to ensure order processes are not only completed, but completed correctly, consistently, and in alignment with payer requirements, company policies, standard operating procedures, privacy expectations, and compliance obligations.
Core Competencies- Quality Governance: Defines, maintains, and strengthens quality standards, audit expectations, scoring methodology, decision documentation, and quality controls across order processes.
- Process Design & Decision Discipline: Evaluates whether workflows, handoffs, decision points, and review criteria produce correct, compliant, and efficient outcomes.
- Compliance & Risk Awareness: Identifies process variation, documentation risk, payer-rule inconsistencies, and operational practices that could create compliance exposure or downstream claim risk.
- Data-Driven Performance Management: Owns scorecard design, metric definitions, reporting cadence, trend analysis, and leadership-level interpretation of quality performance.
- Audit Oversight: Oversees process audits and QA routines to ensure sampling, scoring, documentation, and readouts are consistent, meaningful, and actionable.
- Cross-Functional Influence: Partners with Training, Compliance, Order Management, Billing, Revenue Integrity, and system/workflow owners to translate quality findings into sustainable improvements.
- Root-Cause Problem Solving: Identifies whether quality failures are caused by training gaps, unclear standards, system limitations, payer changes, workflow design, handoff failures, or individual execution issues.
- Executive Communication: Communicates findings, risks, decisions needed, and recommended actions clearly to leadership audiences.
Essential Duties & Responsibilities - Own the order quality governance framework, including quality standards, audit rubrics, scorecard definitions, review expectations, and decision documentation standards.
- Evaluate order processing workflows to determine whether work is being completed accurately, compliantly, and efficiently across intake, documentation review, payer requirement application, handoffs, escalations, and quality review stages.
- Identify gaps in processes that are incorrect, inefficient, inconsistent, unclear, duplicative, manual, or not aligned with payer requirements, compliance standards, or operational objectives.
- Oversee the process audits and QA reviews completed within the Order Management Organization, including sampling approach, audit criteria, reviewer calibration, scoring consistency, documentation of findings, and leadership readouts.
- Develop, maintain, and disseminate recurring scorecard metrics that measure order quality, process accuracy, compliance adherence, defect trends, QA outcomes, audit performance, rework drivers, and process improvement progress.
- Translate QA and audit findings into actionable insights, including root-cause analysis, training needs, compliance risks, workflow changes, system improvements, and leadership decision points.
- Partner regularly with the Training department to ensure training materials, onboarding content, refresher education, job aids, and coaching tools reflect current quality expectations, payer requirements, process standards, and audit findings.
- Partner regularly with Compliance to validate that quality standards, audit routines, escalation pathways, documentation expectations, and process changes align with company policies, healthcare compliance obligations, payer guidance, privacy expectations, and audit readiness needs.
- Facilitate calibration discussions with operational leaders, quality reviewers, process owners, Training, and Compliance to promote consistent interpretation and application of order processing standards.
- Present quality trends, audit results, scorecard outcomes, risks, and recommended corrective actions to Order Management leadership and other cross-functional stakeholders.
- Recommend process redesign, control enhancements, decision rights, handoff improvements, system changes, reporting changes, or training interventions when quality findings indicate preventable defects or avoidable operational friction.
- Maintain governance documentation, including quality standards, audit tools, scorecard definitions, defect categories, process change recommendations, calibration notes, and evidence of follow-up actions.
- Monitor effectiveness of corrective actions by evaluating post-training results, audit trends, repeat defects, compliance findings, and operational performance data.
- Serve as a strategic subject matter expert for order quality, process control, workflow design, audit readiness, and quality measurement across the Order Management Organization.
Qualifications - Minimum of five years of people leadership experience in durable medical equipment, healthcare operations, order management, quality assurance, documentation review, payer requirements, claims readiness, compliance operations, or a related regulated healthcare environment.
- Demonstrated experience conducting or overseeing quality audits, process audits, QA reviews, calibration discussions, scorecards, dashboards, or operational reporting.
- Ability to identify process gaps, root causes, quality trends, compliance risks, inefficiencies, and opportunities for control improvement.
- Strong analytical skills with the ability to convert audit findings and operational data into clear recommendations and leadership-level insights.
- Excellent written and verbal communication skills, including the ability to present findings, explain standards, document decisions, and influence cross-functional partners without direct authority.
- Experience in DME order-to-cash operations, payer policy interpretation, medical necessity documentation, authorization workflows, claims readiness, or revenue cycle feedback loops.
- High attention to detail and strong judgment when interpreting policies, procedures, documentation standards, and payer requirements.
- Proficiency with Microsoft Office applications and experience using operational systems, reporting tools, dashboards, case management systems, or audit trackers.
Preferred Qualifications
- Experience building audit rubrics, defect taxonomies, scorecards, dashboards, or quality reporting structures.
- Strong understanding of DME order workflows, medical documentation requirements, payer criteria, insurance verification, authorization processes, and downstream claim implications.
- Experience partnering with Training and Compliance teams to translate quality findings into education, policy alignment, and sustainable process improvement.
- Experience supporting system implementations, workflow redesign, automation, process controls, or operational transformation initiatives.
- Bachelor's degree in healthcare administration, business, quality management, organizational leadership, compliance, public health, or a related field preferred; equivalent relevant experience may be considered.
