Credentialing 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 a mission-driven healthcare organization committed to improving the quality of life for individuals and families across Massachusetts. Through innovative home- and community-based services, Vitra supports aging adults, people with disabilities, and individuals with complex care needs supported by a Nurse, and Case Manager, Vitra ensures clients receive compassionate, personalized, and dignified care.

To support our mission and protect the integrity of the care we deliver, Vitra Health is seeking a Caregiver Credentialing Specialist who is passionate about compliance and accuracy and committed to helping our caregivers meet the standards that keep our communities safe and well cared for.

The Caregiver Credentialing Specialist is responsible for the administration, oversight, and continuous improvement of Vitra Health's Adult Foster Care (AFC) caregiver credentialing and compliance program. Reporting to the Revenue Cycle Manager, this role ensures caregivers meet the qualification standards outlined in 130 CMR 408.434, exercises independent judgment in determining credentialing eligibility, interprets regulatory requirements, and maintains audit-ready credentialing processes. The Specialist serves as a subject matter expert on MassHealth AFC caregiver requirements and ensures credentialing activities support regulatory compliance, revenue integrity, and quality outcomes.

Key Responsibilities

• Verify caregiver eligibility and compliance with 130 CMR 408.434, including qualification standards, caseload limits, and onboarding requirements.
• Review, validate, and determine the completeness of credentialing documentation, TB requirements, annual training, and all required onboarding documentation before approving caregivers for service.
• Initiate, track, and adjudicate required pre-service and ongoing monthly screenings, including Criminal Offender Record Information (CORI), Sex Offender Registry Information (SORI), and Office of Inspector General (OIG)/federal exclusion-list checks.
• Escalate potentially disqualifying findings to HR, the Program Director, and the Revenue Cycle Manager, and ensure no caregiver begins providing services until all required clearances have been completed.
• Exercise independent judgment in evaluating credentialing issues, interpreting MassHealth regulations, and recommending appropriate actions for noncompliance.
• Develop, maintain, and improve credentialing policies, workflows, and internal controls to ensure regulatory compliance and operational efficiency.
• Maintain recredentialing schedules, monitor compliance deadlines, and ensure continuous compliance with state and federal requirements.
• Build and maintain complete, confidential, and audit-ready credentialing files and prepare documentation for regulatory reviews and internal audits.
• Analyze credentialing trends, identify compliance risks, and recommend process improvements to leadership.
• Partner with Nurses, Case Managers, Revenue Cycle, and Program leadership to resolve credentialing issues and ensure timely, compliant member authorizations and billing.
• Serve as the primary resource for caregiver credentialing questions and stay current on changes to MassHealth AFC regulations and accreditation standards.
• Perform other duties as assigned.

What We Are Looking For

• Associate's or Bachelor's degree, or an equivalent combination of education and experience.
• Three or more years of experience in credentialing, healthcare compliance, provider enrollment, revenue cycle, or healthcare operations.
• Working knowledge of the 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.

Physical and Environmental Demands

• Please note this position is fully in office Monday-Friday in Boston, MA

• Works in a clean, well-lit environment with fluctuating temperatures in close proximity to others.
• Requires substantial periods of repetitive work utilizing a computer, monitor, keyboard, and mouse.
• Requires lifting and carrying equipment and supplies weighing up to 35 pounds; require pushing and pulling equipment and supplies weighing up to 35 pounds; require walking and standing; requires frequent sitting more than 75% of the workday; requires the ability to navigate stairs; requires visual acuity and manual dexterity to operate equipment.

Perks and Benefits

• Health Insurance with a competitive employer contribution.
• Dental and Vision Benefits.
• 401K plan with a company 5% match.
• Paid-Time Off.
• Competitive Pay Rates.
• Wellness Benefits.
• Tuition Reimbursement.
• Supportive team structure and company culture with a focus on work/life balance.

VITRA Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, pregnancy, sexual orientation, gender identity, national origin, age, protected veteran status, or disability status.