Caregiver Credentialing & Compliance Specialist

Vitra Health; Boston (MA); Hybrid; USD 65,000 - 90,000; Full time

Benefits offered by this job

Health Insurance

Dental and Vision Benefits

401K plan with company 5% match

Paid-Time Off

Competitive Pay Rates

Wellness Benefits

Tuition Reimbursement

Supportive team structure and culture

Job summary

Vitra Health is seeking a Caregiver Credentialing Specialist in Boston to administer and improve the AFC credentialing program, ensuring regulators' standards are met. You will verify eligibility, manage screenings, and maintain audit-ready files while collaborating with nursing and program leadership.

The role emphasizes independent judgment, regulatory interpretation, and proactive process improvements to support compliant, timely caregiver onboarding and ongoing credentialing across

Qualifications

• Associate's or Bachelor's degree, or an equivalent combination of education and experience.
• Three or more years of credentialing, healthcare compliance, provider enrollment, revenue cycle, or healthcare operations experience.
• Working knowledge of MassHealth Adult Foster Care program and 130 CMR 408.000 preferred.
• Experience with background screening processes (CORI, SORI, OIG), credentialing systems, and regulatory compliance.
• Strong analytical, organizational, and problem-solving skills with the ability to exercise independent judgment.
• Excellent communication skills, attention to detail, and proficiency with electronic records and Microsoft Office.
• Bilingual skills are a plus.

Responsibilities

• Verify caregiver eligibility and compliance with 130 CMR 408.434 and onboarding requirements.
• Review and validate credentialing documentation, TB requirements, annual training, and onboarding docs before approvals.
• Initiate and adjudicate pre-service and ongoing CORI, SORI, and OIG checks.
• Escalate disqualifying findings to HR, Program Director, and Revenue Cycle Manager; ensure no caregiver begins service before clearances are complete.
• Evaluate credentialing issues, interpret MassHealth regulations, and recommend actions for noncompliance.
• Develop, maintain, and improve credentialing policies, workflows, and internal controls.
• Maintain recredentialing schedules and monitor compliance deadlines.
• Build confidential, audit-ready credentialing files for regulatory reviews.
• Analyze credentialing trends and risks; recommend improvements to leadership.
• Collaborate with Nurses, Case Managers, Revenue Cycle, and Program leadership to resolve credentialing issues.
• Serve as primary resource on MassHealth AFC regulations and accreditation standards.
• Perform other duties as assigned.

Skills

Credentialing

Healthcare compliance

Regulatory knowledge

Background checks (CORI/SORI/OIG)

Microsoft Office

Education

Associate's or Bachelor's degree

Tools

Credentialing systems

Job description

Vitra Health is seeking a Caregiver Credentialing Specialist in Boston to administer and improve the AFC credentialing program, ensuring regulators' standards are met. You will verify eligibility, manage screenings, and maintain audit-ready files while collaborating with nursing and program leadership.

The role emphasizes independent judgment, regulatory interpretation, and proactive process improvements to support compliant, timely caregiver onboarding and ongoing credentialing across