Revenue Eligibility, Credentialing, and Recovery Analyst

Prince William County Government•Prince William County, VA

2d•Onsite

About The Position

Prince William County Community Services is seeking an analytical, detail-oriented professional for its revenue management team. Community Services is a community-based behavioral health organization serving individuals and families throughout Prince William County. The Revenue Eligibility and Credentialing Analyst performs advanced technical, analytical, reconciliation, quality assurance, and compliance work across revenue eligibility, financial assessments, provider credentialing, self-pay accounts receivable, revenue recovery, and related functions. The position operates as a technical resource and liaison among Community Services programs, clinical and administrative teams, fiscal operations, managed care organizations, state collection entities, and other stakeholders. Under the general supervision of the Revenue Eligibility and Credentialing Supervisor, the Analyst helps ensure clinical providers are appropriately credentialed, individuals served are properly assessed for financial eligibility, and delinquent accounts are handled in accordance with applicable laws, regulations, payer rules, and agency policies. The role includes day-to-day execution and compliance monitoring of financial assessments, fee agreements, self-pay accounts receivable, Medicaid and government benefit eligibility, provider enrollment, and debt setoff collections. The work location is a Community Services location in Woodbridge or Manassas, and the schedule is Monday through Friday, 8:30 a.m. to 5:00 p.m., with a one-hour lunch. The hiring salary range is $76,069.50–$104,676.00 annually. Employment is contingent upon passing a fingerprint-based national criminal history record check. The candidate must also pass a DMV record check and TB test and possess a valid driver’s license. A Virginia child abuse and neglect registry search will be conducted as required for DBHDS-licensed providers.

Requirements

High school diploma or G.E.D.
Five years of related experience with credentialing clinical staff, executing Medicaid eligibility in the Commonwealth of Virginia, and government assistance programs.
Analytical, organizational, problem-solving, and decision-making skills, with strong attention to detail.
Ability to interpret complex state and federal regulations, payer guidelines, and accounting requirements.
Strong communication and interpersonal skills, including the ability to build collaborative relationships with clinical, administrative, fiscal, governmental, and external stakeholders.
Proficiency with electronic health records, state portal systems, Microsoft Excel, Microsoft Office applications, financial or administrative systems, and other relevant software.
Ability to prioritize competing responsibilities, manage multiple deadlines, interpret regulatory requirements, and lead staff in a fast-paced environment.
Ability to identify operational and fiscal risks and develop practical solutions that improve compliance, efficiency, and revenue outcomes.
Valid driver’s license.
Must pass a DMV record check and TB test.
Must pass a fingerprint-based national criminal history record check as a condition of employment.

Nice To Haves

Professional experience executing or auditing healthcare revenue cycles, financial assessments, sliding fee scales, or commercial or government insurance billing.
Direct experience initiating and maintaining clinical provider enrollment portfolios using CAQH ProView, PECOS, and PRSS.
Hands-on experience coordinating collection programs, managing aging self-pay accounts receivable, or administering a state tax intercept portal such as Virginia Department of Taxation Debt Setoff Collection.
Experience supervising healthcare, behavioral health, human services, eligibility, credentialing, reimbursement, and revenue recovery functions.
Experience with Virginia Medicaid (DMAS), Medicaid Managed Care Organizations, Medicare, commercial insurance, and other healthcare benefit programs.
Experience with provider credentialing and enrollment.
Experience with financial assessments, fee agreements, self-pay, debt recovery, or debt setoff processes.
Experience interpreting federal, state, payer, or agency regulations and implementing related policies and procedures.
Experience analyzing financial or operational data and developing process improvements.
Knowledge of Medicaid eligibility and enrollment processes, healthcare reimbursement, financial assessments, fee agreements, self-pay, revenue recovery, and debt collection practices.
Knowledge of federal and state regulations governing healthcare reimbursement, eligibility, credentialing, privacy, and financial recovery.

Responsibilities

Conduct revenue eligibility, financial assessments, Medicaid and benefit eligibility, fee agreement, self-pay, credentialing, provider enrollment, and debt recovery operations.
Ensure compliance with applicable federal, state, local, payer, and agency regulations, policies, and financial requirements.
Monitor individual-served status, identify changes affecting reimbursement or financial responsibility, address missed revenue opportunities, and improve collection and recovery outcomes.
Conduct initial applications, re-credentialing, and continuous compliance monitoring for clinical staff through CAQH, PECOS, PRSS, and Virginia Medicaid Managed Care Organizations.
Conduct, review, and execute complex financial assessments, sliding fee scales, and fee agreements.
Investigate and resolve insurance eligibility issues, enrollment errors, and changes affecting reimbursement status to maximize appropriate coverage.
Manage Medicaid and benefit eligibility processes, including screening, application preparation, renewals, ongoing monitoring, and resolution of complex enrollment issues.
Review and establish eligible debts, refer debts for collection, and electronically compile, reconcile, and securely transfer delinquent client accounts to the Virginia Department of Taxation Setoff Debt Collection program.
Run, monitor, and reconcile operational, financial, and performance data logs; analyze trends, discrepancies, risks, and compliance issues involving aging accounts receivable, self-pay portfolios, and credentialing lifecycles.
Recommend or implement corrective process improvements to the Supervisor.
Audit administrative files, eligibility metrics, and debt determinations to identify compliance risks or process deficiencies.
Formulate written responses to complex billing disputes and formal appeals within mandated agency timelines.
Assist in developing and maintaining operational procedures, internal controls, and workflow standards across eligibility, revenue, credentialing, and recovery functions.
Serve as a technical liaison among clinical staff, fiscal operations, compliance teams, Medicaid, MCOs, state collection entities, and other governmental or regulatory bodies.

Benefits

Retirement from the Virginia Retirement System (VRS).
401a and 457 retirement savings and investment plans.
Paid annual leave.
Paid personal leave.
Paid sick leave.
Paid holidays.
Optional group medical and dental health plans.
Optional group life insurance.
Employee Assistance Program (EAP).
Career development opportunities.
Full-time positions with Prince William County Government qualify for Public Service Loan Forgiveness.