Revenue Eligibility & Credentialing Analyst

Prince William County; Virginia; On-site; USD 76,000 - 105,000; Full time

Benefits offered by this job

Retirement from the Virginia RETIRE

401a and 457 plans

Paid Annual Leave

Paid Personal Leave

Paid Sick Leave

Paid Holidays

Group Medical and Dental Plans

Group Life Insurance

Employee Assistance Program

Career Development Opportunities

Job summary

Prince William County Community Services seeks an analytical, detail-oriented Revenue Eligibility and Credentialing Analyst to support revenue cycle integrity, credentialing, and Medicaid eligibility across CAQH, PECOS, PRSS, and Virginia Medicaid MCOs. The role emphasizes data accuracy, regulatory compliance, and cross-team collaboration.

Proficiency in Microsoft Excel, strong problem-solving skills, and the ability to manage multiple priorities with clinical and fiscal stakeholders are

Qualifications

• High school diploma or GED required with 5 years in credentialing, Medicaid eligibility, and government programs.
• Experience with credentialing clinical staff and Medicaid eligibility processes preferred.
• Experience interpreting federal/state regulations and payer guidelines.

Responsibilities

• Conduct revenue eligibility, financial assessments, Medicaid eligibility, fee agreements, self-pay, credentialing, and debt recovery operations.
• Ensure compliance with federal, state, local, payer, and agency regulations and financial requirements.
• Lead revenue maximization and recovery by monitoring status and addressing missed revenue opportunities.

Skills

Analytical thinking

Detail-oriented

Regulatory compliance

Communication

Education

High school diploma or GED

Tools

CAQH ProView

PECOS

PRSS

Virginia Medicaid MCO portals

Job description

Prince William County Community Services seeks an analytical, detail-oriented Revenue Eligibility and Credentialing Analyst to support revenue cycle integrity, credentialing, and Medicaid eligibility across CAQH, PECOS, PRSS, and Virginia Medicaid MCOs. The role emphasizes data accuracy, regulatory compliance, and cross-team collaboration.

Proficiency in Microsoft Excel, strong problem-solving skills, and the ability to manage multiple priorities with clinical and fiscal stakeholders are