Credentialing Specialist

Loudoun County Government has been named one of Forbes' 2025 Best Large Employers! We're proud to be recognized nationally for our commitment to employee satisfaction and excellence in public service. At Loudoun County, we bring together talented professionals from all backgrounds to make a meaningful impact in a dynamic, growing community - that's The Loudoun Difference.

Welcome and thank you for your interest in employment with Loudoun County Government!

ALL SECTIONS OF THE APPLICATION MUST BE COMPLETED IN ITS ENTIRETY. THE RESUME IS CONSIDERED SUPPLEMENTAL INFORMATION ONLY. APPLICATIONS THAT ARE INCOMPLETE OR INDICATE 'SEE RESUME' WILL NOT BE TAKEN INTO CONSIDERATION.

Loudoun County Department of Mental Health, Substance Abuse and Developmental Services is seeking a detail-oriented and highly organized Credentialing Specialist to join the Finance program. As part of a collaborative team, the Credentialing Specialist is responsible for managing the verification and enrollment process for healthcare providers to ensure compliance with state, federal and organizational standards. This role supports accurate and timely provider onboarding while maintaining essential credentialing documentation and working closely with internal staff, providers and insurance payers. In this role, you will work with a trusted and reputable team that has a history of success connecting individuals and their families with person-centered, recovery-oriented services and supports.

Duties include but are not limited to:

• Serve as the point person for all credentialing and re-credentialing activities associated with both facility and individual providers for Medicare, Medicaid, 3rd Party Payers, Managed Care Organizations (MCO's), and any health plans according to their specification.
• Manage correspondences with the Centers for Medicare & Medicaid Services (CMS), State Medicaid, MCOs, third-party payers, including updates, applications, and re-validation paperwork.
• Stay current with credentialing standards for both Behavioral Health and Developmental Disabilities provider staff for all Federal, State and local regulatory agencies.
• Maintain and update licensing and credentialing records, documentation and databases with a high degree of accuracy.
• Collaborate with internal teams, State partners, and insurance carriers to ensure that all credential requirements for billing are completed in a timely manner to maximize revenue generation.
• Ensures credentialing activities are conducted in a manner consistent with County and Department policies and procedures and are in compliance with Federal, State, and payer regulations, guidelines, and requirements.

• Extensive knowledge of Medicaid, Medicare and managed care credentialing processes.
• Strong attention to detail.
• The ability to manage multiple deadlines.
• Proficiency with credentialing databases.
• Experience with Microsoft Office applications.
• Excellent written and verbal communication skills.

Bachelor's degree in Business, Finance, Healthcare Administration, or a related field and one (1) year of related work experience in medical billing/credentialing or equivalent combination of education and experience.

Preferred:

• Certified Provider Credentialing Specialist (CPCS) or eligibility to obtain certification.
• Experience with CAQH, NPI registry, PECOS and MCO portals.
• Familiarity with Virginia DBHDS requirements or applicable state regulations.
  

Valid driver's license and good driving record (driving records may be reviewed annually for continued qualification). Pass pre-employment background checks, including fingerprint, NCIC, and DMV checks.