Credentialing Specialist

About the Role

Vitra Health is seeking a Caregiver Credentialing Specialist to administer, oversee, and continuously improve our Adult Foster Care (AFC) caregiver credentialing and compliance program. This role 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. The Specialist serves as a subject matter expert on MassHealth AFC caregiver requirements, supporting regulatory compliance, revenue integrity, and quality outcomes.

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, ensuring no caregiver begins providing services until all required clearances are 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.

Requirements

• 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

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

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.
• Supplemental Benefits: Life, Accident, Critical Illness, and Disability Insurance.
• Supportive team structure and company culture with a focus on work/life balance.