Revenue Eligibility, Credentialing, and Recovery Analyst

Revenue Eligibility, Credentialing, and Recovery Analyst

Salary

$70,921.50 - $125,014.50 Annually

Location

Prince William County, VA

Job Type

Full-Time (FT)

Job Number

202610892

Department

COMMUNITY SERVICES

Division

Administrative Services

Opening Date

10/22/2026

Closing Date

11/5/2026 11:59 PM Eastern

GRADE

C42

Hiring Salary

$76,069.50 - $104,676.00 Annually

• Description
• Benefits
• Questions

Introduction

Prince William County Community Services is seeking an analytical, detail-oriented professional to join our revenue management team as a Revenue Eligibility and Credentialing Analyst. 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 bridges clinical compliance and revenue cycle integrity. Under the general supervision of the Revenue Eligibility and Credentialing Supervisor, you will perform high-level analytical work across provider credentialing, financial assessments, self-pay accounts receivable, revenue recovery, and/or state debt collections. If you possess strong problem-solving skills and a deep understanding of healthcare revenue cycles, apply today.

About This Role

The Revenue Eligibility and Credentialing Analyst provides advanced subject-matter execution, data reconciliation, and analytical support for revenue-related administrative functions within Community Services. Operating as a technical resource within the unit, this position ensures that clinical providers are accurately credentialed, individuals served are properly assessed for financial eligibility, and delinquent accounts are recovered in compliance with the Code of Virginia, Virginia Department of Behavioral Health and Developmental Services (DBHDS) requirements, federal laws, and payer regulations.

This position is responsible for the day-to-day execution, quality assurance testing, and compliance monitoring of activities involving revenue eligibility, financial assessments, fee agreements, self-pay accounts receivable, Medicaid and government benefit eligibility, clinical credentialing, provider enrollment, and/or debt setoff collection processes.

Serving as a key technical liaison and subject-matter resource, the Analyst collaborates across Community Services programs, clinical and administrative teams, fiscal operations, Managed Care Organizations (MCOs), state collection entities, and other internal and external stakeholders to streamline revenue outcomes and minimize fiscal risk

Key responsibilities include:

• 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 individuals 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.

The Successful Candidate Will Have

The successful candidate will be an analytical, detail-oriented professional who possesses strong problem-solving and financial reconciliation skills within a behavioral healthcare or medical environment. They bring a proven capability to interpret complex state and federal regulations, payer guidelines, and accounting requirements, alongside advanced proficiency in electronic health records (EHR) environments, state portal systems, and Microsoft Excel for data tracking and analytics. As a highly collaborative subject-matter resource, they demonstrate strong organizational, communication, and decision-making skills, allowing them to manage competing priorities and partner effectively with clinical, administrative, fiscal, and external governmental stakeholders. Passionate about strengthening fiscal accountability, maximizing benefit resources, and ensuring compliance.

If you are an analytical, collaborative professional who is passionate about driving revenue integrity, strengthening fiscal accountability, maximizing appropriate benefit resources, and ensuring strict regulatory compliance in a behavioral healthcare environment, we encourage you to apply and become part of the Prince William County Community Services team.

Minimum Requirements: 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.

Preferences:

• Professional experience executing or auditing healthcare revenue cycles, financial assessments, sliding fee scales, or commercial/government insurance billing.
• Direct experience in initiating and maintaining clinical provider enrollment portfolios utilizing state and federal portals including 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 the Virginia Department of Taxation Debt Setoff Collection program.
• 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 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.

Special Requirements (if applicable):

• Must possess a valid driver's license.
• Must pass a DMV record check.
• Must pass TB test.
• Offer of employment is contingent upon the candidate passing a fingerprint-based national criminal history record check.

Child Protective Services Requirements: Effective 1999, mandated by the Virginia Department of Behavioral Health and Developmental Services (DBHDS) in accordance with 12VA35-105-400 rules and regulations for DBHDS Licensed Providers and related to the Criminal Registry Checks, a search of the registry of founded complaints of child abuse and neglect will be conducted by the Virginia Department of Social Services.

Work Schedule: The work hours will be Monday through Friday, 8:30 AM - 5:00 PM, with a one-hour lunch. The position will work at of the Community Services locations in Woodbridge or Manassas.

Hiring Salary Range: $76,069.50 - $104,676.00 Annually

We also offer great benefits, including:

• 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
• An Employee Assistance Program (EAP)
• Career Development Opportunities

Full-time positions with Prince William County Government qualify for Public Service Loan Forgiveness. Click here for PSLF for additional information.

NOTE: The above position description is intended to represent only the key areas of responsibilities; specific position assignments will vary depending on the business needs of the department. To view the class description in its entirety, click here.

Prince William County is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the County will provide reasonable accommodations to qualified individuals with disabilities and encourages both prospective and current employees to discuss potential accommodations with the employer.

SEE YOURSELF HERE!

Prince William County Government offers medical plans with corresponding pharmacy and basic vision coverage, as well as dental plans and a separate vision plan.

Full-time and part-time Prince William County Government employees are eligible to participate in our plans; however, the level and cost of benefits depends on the classification of the position.

The following positions do not accrue leave and are not eligible for holidays or other fringe benefits:

• Temporary
• Provisional
• Seasonal employees

Click on the link below to explore our plans and rates.

Prince William County Benefit Programs

01

By submitting this application, I understand the following: 1) Only the information provided on my application is used to determine my qualifications; 2) My resume will not substitute for the education, work experience, and required fields on the Prince William County application; 3) Only responses to Supplemental Questions that can be verified in my submitted education and work experience will be credited and 4) If selected, my employment dates will be verified for the past three (3) years (if applicable), with a required reference from my current or most recent employer.

• Yes, I acknowledge and understand the above statement and wish to continue in this process.
• No, I do not wish to proceed any further in this process.

02

Please select your highest level of completed education.

• Masters degree or higher
• Bachelors degree
• Associates degree
• High school diploma/GED
• None of the above

03

This position requires at least five (5) years of experience in analytical, paraprofessional, healthcare, behavioral health, eligibility, credentialing, financial, revenue recovery, or related administrative fields. Do you have five or more years of this experience?

• Yes
• No

04

How many years of professional experience do you possess managing healthcare provider credentialing or medical revenue cycle workflows (such as insurance verification, sliding fee calculations, and financial eligibility screening)?

• 4 or more years
• 3 years
• 2 years
• 1 year
• Less than 1 year
• No experience

05

Eligibility and Financial Responsibility - please select all areas in which you have direct professional experience.

• Financial assessments or ability-to-pay determinations
• Fee assessments or fee agreements
• Calculating sliding fee agreements
• Resolving complex health insurance eligibility discrepancies
• Medicaid eligibility screening or enrollment
• Medicaid renewals and ongoing eligibility monitoring
• Government benefit eligibility
• Insurance eligibility verification
• Self-pay assessment or account management
• Monitoring changes in client financial or benefit status
• Financial responsibility disputes or appeals
• Identifying missed reimbursement or revenue opportunities
• None of the above

06

Medicaid, Insurance and Benefit Programs - select all programs or payer types with which you have direct professional experience.

• Virginia Medicaid (DMAS)
• Medicaid Managed Care Organizations (MCOs)
• Medicare
• Commercial insurance
• Self-pay
• Other government benefit programs
• None of the above

07

If you selected "Other Government Benefit Programs" in the question above, please list the systems below.

08

Which of the following provider enrollment, credentialing, or government billing systems do you have direct, hands-on experience utilizing? (Select all that apply)

• Initial provider credentialing
• Re-credentialing
• License and certification monitoring
• Provider enrollment
• Virginia Medicaid provider enrollment
• Medicaid MCO enrollment
• CAQH
• PECOS
• PRSS
• Automated State Tax Intercept / Debt Setoff Portals
• Provider Express
• Availity
• Monitoring credentialing/enrollment compliance deadlines
• Resolving credentialing or enrollment discrepancies
• None of the above

09

Debt Recovery and Setoff - select all debt recovery activities with which you have direct professional experience.

• Delinquent account review
• Debt determination or establishment
• Collection referrals
• Payment plans or account resolution
• Collection agency coordination
• Debt recovery monitoring and reporting
• Government debt setoff
• Virginia Department of Taxation debt setoff
• Federal/IRS debt collection or offset processes
• Review or escalation of disputed accounts
• Recovery trend analysis
• None of the above

10

Regulatory and Compliance Experience - select all areas in which you have professional experience interpreting, applying, monitoring, or ensuring compliance with requirements.

• Virginia Medicaid (DMAS) requirements
• Medicaid MCO requirements
• Medicare requirements
• Federal healthcare or reimbursement regulations
• State healthcare or reimbursement regulations
• Provider credentialing/enrollment requirements
• HIPAA/privacy requirements
• 42 CFR Part 2 requirements
• Financial or revenue-related compliance requirements
• Documentation compliance reviews
• None of the above

11

Data Analysis, Quality Assurance and Reporting - select all activities you have performed or supervised.

• Eligibility reporting
• Credentialing compliance reporting
• Debt recovery reporting
• Financial or operational reconciliation
• Quality assurance reviews
• Identification and correction of discrepancies
• Trend analysis
• None of the above

12

Healthcare/Behavioral Health Environment - select all environments in which you have direct professional experience.

• Community Services Board
• Behavioral Health
• Local Government
• State Government
• Federal Government
• Hospital/Health System
• Physician Practice
• Community Health
• Human Services
• None of the above

13

External Stakeholder Experience - select all organizations or stakeholder groups with which you have professionally coordinated regarding eligibility, credentialing, reimbursement, financial responsibility, or recovery.

• Virginia Department of Medical Assistance Services (DMAS)
• Medicaid Managed Care Organizations
• Medicare
• Commercial insurance organizations
• Virginia Department of Taxation
• Government benefit agencies
• Collection agencies
• Healthcare providers or credentialing organizations
• Regulatory or auditing entities
• None of the above

14

Microsoft Office Experience - please indicate each of the following software applications that you have professional experience with.

• Excel
• Word
• Outlook
• Teams
• PowerPoint
• Webex
• None of the above

Required Question

Employer Prince William County Government

Address 1 County Complex Court

Prince William County, Virginia, 22192

Website https://www.pwcva.gov/department/human-resources/careers