Senior Credentialing Specialist

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

About Vitra Health

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 help share our mission and expand our community impact, Vitra Health is seeking a Senior Credentialing Specialist who is passionate about community engagement and helping people access the care and resources they deserve.

The Opportunity

The Senior Credentialing Specialist is responsible for the strategic 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 serves as the organization's lead subject matter expert for caregiver credentialing and regulatory compliance, ensuring all credentialing activities align with MassHealth regulations, organizational policies, and audit requirements.

The Senior Credentialing Specialist exercises independent judgment in evaluating caregiver eligibility, interpreting regulatory requirements, assessing compliance risks, and recommending corrective actions. This role plays a critical part in protecting Vitra's regulatory standing, revenue integrity, and quality outcomes by ensuring caregivers meet all credentialing and compliance requirements before and during service delivery.

The ideal candidate combines deep credentialing expertise with strong compliance acumen, operational leadership, and the ability to drive process improvements across multiple departments.

Key Responsibilities

Credentialing Program Leadership

• 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.

Compliance Oversight & Risk Management

• 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.

Regulatory & Audit Leadership

• 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.

Program Development & Process Improvement

• 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.

Cross-Functional Collaboration

• 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.

Additional Responsibilities

• 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

What We Are Looking For

• This is a full-time, in-person position based in Boston, Massachusetts.

• The successful candidate must be able to regularly work from Vitra Health's Boston location and travel to other Vitra Health locations depending on business needs.

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health, Human Services, or a 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.

• Strong knowledge of healthcare regulatory requirements, compliance standards, and audit preparation.

• Exceptional organizational, analytical, and problem-solving skills.

• Ability to exercise sound professional judgment and make independent decisions within established guidelines.

• Advanced proficiency with Microsoft Office applications, electronic health records, credentialing platforms, and compliance tracking systems.

Preferred Qualifications

• Working knowledge of the MassHealth Adult Foster Care Program and 130 CMR 408.000 regulations.

• Experience supporting audits, regulatory reviews, and corrective action initiatives.

• Certified Provider Credentialing Specialist (CPCS) or similar credential preferred.

• Experience in home health, community-based services, long-term services and supports (LTSS), or MassHealth programs.

• Bilingual skills strongly preferred.

Work Environment and Physical Requirements

• Office-based work in a clean well-lit environment with fluctuating temperatures near others.

• Client-facing field staff and community liaisons require frequent travel to client homes or community settings; ability to drive safely; work in client homes may involve varying temperatures, odors, allergens, pets, and other environmental factors.

• 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; requires pushing and pulling equipment and supplies weighing up to 35 pounds; requires walking and standing; requires frequent sitting more than 75% of the workday; requires the ability to negotiate stairs; requires visual acuity and manual dexterity to operate equipment.

Perks and Benefits

• Employer sponsored health Insurance with a generous employer match.

• Dental and Vision Benefits.

• Supplemental Benefits

• Life, Accident, Critical Illness and Disability Insurance.

• 401K with a 5% company match.

• Accrued Paid-Time-Off.

• Ten company paid holidays.

• 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.