Revenue Eligibility & Credentialing Supervisor

Prince William County Government • Prince William County, VA

5d • Onsite

About The Position

Prince William County Community Services is seeking a motivated, experienced individual to join our revenue management team as the Eligibility, Credentialing, and Recovery Supervisor. Community Services is a large, community-based behavioral health organization providing a broad range of services to individuals and families throughout Prince William County. This position provides operational supervision and subject-matter leadership for revenue eligibility, financial assessments, fee agreements, Medicaid and benefit eligibility, provider credentialing and enrollment, self-pay, debt recovery, and related fiscal activities. The position supervises professional-level staff, assigns and monitors work, ensures compliance with applicable regulations and payer requirements, and supports processes designed to maximize appropriate reimbursement and revenue recovery. The Eligibility, Credentialing, and Recovery Supervisor provides operational supervision and subject-matter leadership for revenue-related administrative functions supporting individuals served by Community Services. This position ensures that individuals are appropriately assessed for financial responsibility and benefit eligibility, that eligible Medicaid and other benefit resources are identified and pursued, that providers are appropriately credentialed and enrolled, and that available revenue and recovery opportunities are effectively managed. The position provides day-to-day supervision, quality assurance, workload management, staff development, process improvement, and compliance oversight for activities involving revenue eligibility, financial assessments, fee agreements, self-pay, Medicaid and government benefit eligibility, clinical credentialing and provider enrollment, debt setup and determination, debt setoff and collection processes, and ongoing monitoring of client financial and benefit status. The Supervisor serves as a key liaison among Community Services programs, clinical and administrative staff, fiscal operations, Medicaid and other governmental entities, managed care organizations, credentialing and enrollment systems, collection entities, and other internal and external stakeholders.

Requirements

• High school diploma or G.E.D.
• 6 years of analytical, paraprofessional, healthcare, behavioral health, eligibility, credentialing, financial, revenue recovery, or related administrative experience.
• Proficiency with Microsoft Office and other computer applications used in performing assigned duties is required.

Nice To Haves

• Experience supervising healthcare, behavioral health, human services, eligibility, credentialing, reimbursement, and revenue recovery functions.
• Experience with Virginia Medicaid (DMAS), Medicaid Managed Care Organizations (MCOs), 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 in 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.
• Strong analytical, organizational, problem-solving, and decision-making skills with exceptional attention to detail.
• Excellent communication and interpersonal skills, with the ability to establish collaborative relationships with clinical, administrative, fiscal, governmental, and external stakeholders.
• Proficiency with electronic health records, financial or administrative systems, Microsoft Office applications, and other software utilized in the performance of assigned duties.
• 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.

Responsibilities

• Supervises revenue eligibility, financial assessments, Medicaid and benefit eligibility, fee agreements, self-pay, credentialing, provider enrollment, and debt recovery operations.
• Ensure compliance with applicable federal, state, local, payer, and agency regulations, policies, and financial requirements.
• Leads revenue maximization and recovery efforts by monitoring client status, identifying changes affecting reimbursement or financial responsibility, addressing missed revenue opportunities, and improving collection and recovery outcomes.
• Oversee Medicaid and benefit eligibility processes, including screening, applications, renewals, ongoing monitoring, and resolution of eligibility issues to maximize appropriate reimbursement.
• Oversee provider credentialing and enrollment to ensure required licenses, certifications, enrollments, and related documentation remain current and compliant and to minimize disruptions or loss of reimbursement.
• Directs debt recovery activities, including review and establishment of eligible debts, referrals for collection and setoff, monitoring recovery activity, and ensuring compliance with applicable laws, regulations, and due-process requirements.
• Analyzes operational, financial, and performance data; conducts quality assurance and reconciliations; identifies trends, discrepancies, risks, and compliance issues; and implements or recommends corrective and process improvements.
• Supervises assigned staff by assigning and prioritizing work, establishing performance expectations, providing training and coaching, evaluating performance, supporting recruitment and professional development, and ensuring continuity of operations.
• Develops and maintains policies, procedures, and workflow standards, and serves as a subject-matter resource for management and staff on eligibility, revenue, credentialing, financial, and debt-recovery matters.
• Coordinates with internal and external stakeholders, including clinical, fiscal, human resources, compliance, Medicaid, managed care organizations, and other governmental or regulatory entities, to resolve complex issues and support effective service delivery and fiscal accountability.

Benefits

• Retirement from the Virginia Retirement System (VRS)
• 401a and 457 retirement savings plans
• Paid Annual Leave / Sick Leave / Personal Leave
• Paid Holidays
• Group Medical, Dental, & Vision Health Plans
• Group Life Insurance
• Employee Assistance Program (EAP)
• Career Development Opportunities
• Full-time positions with Prince William County Government qualify for Public Service Loan Forgiveness.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED