Revenue Integrity & Credentialing Analyst

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

Benefits offered by this job

VRS retirement

401a/457 plans

Paid leave (annual)

Paid personal leave

Paid sick leave

Paid holidays

Medical and dental options

Group life insurance

Employee assistance program

Career development

Job summary

Prince William County Community Services, part of Prince William County Government, seeks an analytical Revenue Eligibility and Credentialing Analyst to support revenue cycle integrity and regulatory compliance. You will manage credentialing, eligibility determinations, and debt recovery processes within Virginia regulations.

The role emphasizes data reconciliation, financial assessments, and collaboration with CSB teams, MCOs, and state entities to maximize reimbursement and minimize fiscal

Qualifications

• High school diploma or G.E.D. and 5 years of related experience with credentialing clinical staff, executing Medicaid eligibility in the Commonwealth of Virginia, and government assistance programs.
• Hands-on experience coordinating collection programs, managing aging self-pay accounts receivable, or administering a state tax intercept portal such as the Virginia Department of Taxation Debt Setoff Collection program.
• Experience with Virginia Medicaid (DMAS), Medicaid Managed Care Organizations (MCOs), Medicare, commercial insurance, and other healthcare benefit programs.
• Knowledge of Medicaid eligibility and enrollment processes, healthcare reimbursement, financial assessments, fee agreements, self-pay, revenue recovery, and debt collection practices.
• 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

• Conduct 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.
• Lead revenue maximization and recovery efforts by monitoring individual served status, identifying changes affecting reimbursement or financial responsibility, addressing missed revenue opportunities, and improving collection and recovery outcomes.
• Conduct initial applications, re-credentialing, and continuous compliance monitoring for clinical staff across CAQH, PECOS, PRSS, and Virginia Medicaid Managed Care Organizations (MCOs) to ensure required documentation remains current.
• Financial Assessment & Benefit Optimization: Conduct, review, and execute complex financial assessments, sliding fee scales, and fee agreements. Investigate and resolve insurance eligibility issues, enrollment errors, and changes affecting an individual's reimbursement status to maximize appropriate coverage.
• Medicaid & Benefit Eligibility Administration: Manage daily Medicaid and benefit eligibility processes, including screening, application preparation, renewals, ongoing monitoring, and the resolution of complex enrollment issues to maximize reimbursement.
• State Debt Recovery Execution: Manage debt recovery activities, including the review and establishment of eligible debts, referrals for collection, and the electronic compilation, reconciliation, and secure transfer of delinquent client accounts to the Virginia Department of Taxation Setoff Debt Collection program.
• Data Analytics & Reconciliation: Run, monitor, and reconcile operational, financial, and performance data logs. Analyze statistical trends, discrepancies, risks, and compliance issues concerning aging accounts receivable, self-pay portfolios, and credentialing lifecycles to implement or recommend corrective process improvements to the Supervisor.
• Quality Assurance & Regulatory Compliance: 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.
• Workflow Standard Development: Serve as the subject-matter resource and assist in developing and maintaining operational procedures, internal controls, and workflow standards across all eligibility, revenue, credentialing, and recovery functions.
• Stakeholder Coordination: Serve as the central technical liaison between CSB clinical staff, fiscal operations, compliance teams, Medicaid, MCOs, state collection entities, and other governmental or regulatory bodies to resolve highly complex issues and support effective fiscal accountability.

Skills

Analytical thinking

Detail-oriented

Data reconciliation

Financial assessments

Excel proficiency

Communication skills

Problem-solving

Education

High school diploma or GED

Tools

CAQH ProView

PECOS

PRSS

EHR systems

Microsoft Excel

Job description

Prince William County Community Services, part of Prince William County Government, seeks an analytical Revenue Eligibility and Credentialing Analyst to support revenue cycle integrity and regulatory compliance. You will manage credentialing, eligibility determinations, and debt recovery processes within Virginia regulations.

The role emphasizes data reconciliation, financial assessments, and collaboration with CSB teams, MCOs, and state entities to maximize reimbursement and minimize fiscal