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 plan

401a/457 plans

Paid annual leave

Paid personal leave

Paid sick leave

Paid holidays

Group medical and dental plans (opt.)

Group life insurance (opt.)

Employee Assistance Program (EAP)

Career development opportunities

Job summary

Prince William County Community Services is seeking a Revenue Eligibility and Credentialing Analyst to support revenue cycle integrity across credentialing, eligibility, and debt recovery functions. The role emphasizes compliance with DBHDS, state, and payer requirements while collaborating with clinical and administrative teams.

The successful candidate will manage daily eligibility processes, financial assessments, and credentialing for providers, ensuring accurate documentation and maximizing

Qualifications

• High school diploma or GED with 5 years of credentialing/ eligibility experience.
• Experience with Medicaid eligibility, debt recovery, and Medicaid/DBHDS requirements preferred.
• Strong analytical and data reconciliation skills; proficient with Excel for tracking and analytics.

Responsibilities

• Conduct revenue eligibility, financial assessments, Medicaid and benefit eligibility, fee agreements, self-pay, credentialing, provider enrollment, and debt recovery operations.
• Ensure compliance with federal, state, local, payer, and agency regulations.
• Lead revenue maximization by monitoring status, identifying changes affecting reimbursement, and improving collection outcomes.
• Perform credentialing activities across CAQH, PECOS, PRSS, and state MCOs to ensure current documentation.
• Analyze data trends and risks to recommend process improvements to the supervisor.

Skills

Analytical thinking

Attention to detail

Regulatory compliance

Communication skills

Problem-solving

Education

High school diploma or GED

Tools

Microsoft Excel

Electronic Health Records (EHR)

Microsoft Office

Job description

Prince William County Community Services is seeking a Revenue Eligibility and Credentialing Analyst to support revenue cycle integrity across credentialing, eligibility, and debt recovery functions. The role emphasizes compliance with DBHDS, state, and payer requirements while collaborating with clinical and administrative teams.

The successful candidate will manage daily eligibility processes, financial assessments, and credentialing for providers, ensuring accurate documentation and maximizing