Revenue Eligibility, Credentialing, and Recovery Analyst

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,

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

• 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 life cycles 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…