Caregiver Credentialing Specialist

About the Role

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. The Caregiver Credentialing Specialist ensures caregivers meet the standards that keep our communities safe and well cared for, playing a critical role in compliance and accuracy.

This position 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, the Specialist ensures caregivers meet qualification standards outlined in 130 CMR 408.434, exercises independent judgment in determining credentialing eligibility, interprets regulatory requirements, and maintains audit-ready credentialing processes.

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.