Senior Credentialing & Compliance Lead

Vitra Health; Boston (MA); On-site; USD 85,000 - 115,000; Full time

Benefits offered by this job

Employer sponsored health Insurance

Dental and Vision Benefits

401K with company match

Paid-Time-Off

Ten company paid holidays

Wellness Benefits

Tuition Reimbursement

Supportive team culture

Job summary

Vitra Health in Boston, MA is seeking a Senior Credentialing Specialist to lead AFC caregiver credentialing and compliance, aligning with MassHealth regulations and audit requirements. You will oversee pre-service and ongoing screenings (CORI, SORI, OIG, SAM), develop workflows, and partner with HR, Revenue Cycle, and clinical leadership to ensure timely onboarding and ongoing regulatory readiness.

This role requires independent judgment, strong analytical skills, and the ability to translate

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health, Human Services, or related field, or equivalent combination of education and experience.
• Five or more years of experience in healthcare credentialing, provider enrollment, compliance, revenue cycle operations, healthcare administration, or a related field.
• Demonstrated experience managing credentialing programs and regulatory compliance processes.
• Experience administering background screening and exclusion-list monitoring programs, including CORI, SORI, OIG, and similar compliance reviews.

Responsibilities

• Serve as the lead administrator and subject matter expert for Vitra Health's AFC caregiver credentialing and compliance program.
• Ensure caregiver eligibility and compliance with all applicable MassHealth AFC regulations, including 130 CMR 408.434 and related regulatory requirements.
• Review, evaluate, and approve credentialing documentation, onboarding requirements, annual training requirements, TB compliance, and supporting records.
• Exercise independent judgment in determining credentialing readiness and compliance status.
• Maintain accountability for the integrity, accuracy, and completeness of caregiver credentialing records.
• Administer and oversee all required pre-service and ongoing screenings, including CORI, SORI, OIG, SAM, and other exclusion-list reviews.
• Evaluate screening results and identify compliance concerns requiring escalation.
• Partner with Human Resources, Program Leadership, and Revenue Cycle leadership to address potentially disqualifying findings and mitigate organizational risk.
• Monitor compliance trends and proactively identify operational and regulatory vulnerabilities.
• Recommend and implement corrective actions to address credentialing and compliance deficiencies.
• Serve as the primary internal resource regarding caregiver credentialing regulations, compliance requirements, and credentialing best practices.
• Interpret state and federal regulatory requirements and translate them into operational processes.
• Maintain audit-ready documentation and oversee preparation for MassHealth reviews, internal audits, external audits, and regulatory inspections.
• Lead credentialing-related audit responses and corrective action plans.
• Monitor regulatory updates and evaluate operational impact, recommending process and policy changes as necessary.
• Develop, implement, and continuously improve credentialing workflows, standard operating procedures, and internal controls.
• Evaluate credentialing processes and identify opportunities to improve quality, efficiency, compliance, and caregiver experience.
• Create and maintain reporting dashboards, metrics, and compliance tracking tools.
• Analyze credentialing performance indicators and provide recommendations to leadership regarding program effectiveness and risk mitigation.
• Collaborate with Nurses, Case Managers, Human Resources, Revenue Cycle, Clinical Leadership, and Operations teams to ensure timely and compliant caregiver onboarding.
• Provide consultation and guidance regarding credentialing requirements, documentation standards, compliance issues, and regulatory expectations.
• Support revenue cycle initiatives by ensuring credentialing activities align with authorization, billing, and reimbursement requirements.
• Participate in compliance initiatives and organizational quality improvement efforts.
• Prepare reports, compliance summaries, and credentialing metrics for leadership review.
• Support organizational accreditation, compliance, and quality initiatives.
• Perform other duties as assigned.
• Fosters a culture of customer service and commitment to qualitycare
• Serves as a brand ambassador for Vitra reflecting our vision, mission, and values
• Shows a genuine interest and compassion for the communities we serve and commitment to the diversity of our clients and teammembers
• Mentor and supports teammembers
• Complete other tasks asassigned

Skills

Organizational skills

Analytical skills

Problem-solving

Independent decision-making

Education

Bachelor's degree in Healthcare Administration or related field

Tools

Microsoft Office

Electronic Health Records (EHR)

Credentialing platforms

Compliance tracking systems

Job description

Vitra Health in Boston, MA is seeking a Senior Credentialing Specialist to lead AFC caregiver credentialing and compliance, aligning with MassHealth regulations and audit requirements. You will oversee pre-service and ongoing screenings (CORI, SORI, OIG, SAM), develop workflows, and partner with HR, Revenue Cycle, and clinical leadership to ensure timely onboarding and ongoing regulatory readiness.

This role requires independent judgment, strong analytical skills, and the ability to translate