Compliance Specialist

St. Joseph's Villa•Richmond, VA

6d•$65,000 - $75,000

About The Position

St. Joseph’s Villa is seeking a detail-oriented, organized Compliance Specialist to support agency-wide regulatory compliance, quality assurance, documentation monitoring, insurance authorization tracking, provider credentialing, reporting, and quality improvement. Under the direction of the Compliance Manager, the Specialist conducts audits, monitors documentation and regulatory requirements, tracks corrective actions, supports insurance and billing processes, and maintains accurate compliance records. The role collaborates with program leadership, Finance, Admissions, Human Resources, and other departments to identify compliance concerns, resolve discrepancies, and support adherence to regulatory, contractual, payer, and agency requirements. The Compliance Specialist assists with monitoring requirements established by the Virginia Department of Behavioral Health and Developmental Services (DBHDS) and the Virginia Department of Education (VDOE), including preparation for licensing visits, regulatory reviews, insurance audits, and other monitoring activities. The successful candidate demonstrates analytical skills, attention to detail, organizational ability, confidentiality, professional ethics, and a commitment to continuous improvement. Responsibilities must align with St. Joseph’s Villa’s mission, values, policies, and guiding principles.

Requirements

Associate degree in business, healthcare administration, human services, behavioral health, education, or a related field.
Strong organizational skills and attention to detail, with the ability to manage multiple priorities and deadlines.
Proficiency with Microsoft Office applications, electronic records systems, databases, and web-based platforms.
Ability to review documentation, maintain accurate records, identify discrepancies, and communicate findings effectively.
Ability to handle confidential information with discretion and professionalism.
Strong written and verbal communication skills and the ability to collaborate across departments.

Responsibilities

Conduct routine and random audits of client records, program documentation, and related records to assess compliance with regulatory, contractual, payer, and agency requirements.
Review documentation for completeness, accuracy, required signatures, authorizations, and other applicable standards.
Document audit findings, communicate deficiencies, track corrective actions through resolution, and conduct follow-up audits to verify corrections.
Assist with preparation for licensing visits, regulatory reviews, insurance audits, payer reviews, and other monitoring activities.
Support monitoring of DBHDS and VDOE requirements through record collection, data tracking, research, and follow-up.
Identify recurring compliance issues, trends, and areas of risk and report findings to the Compliance Manager.
Collaborate with program teams and Finance to obtain information needed to resolve billing and claims issues.
Research unpaid, denied, rejected, or unsubmitted insurance claims and coordinate follow-up.
Reconcile insurance authorizations, services delivered, and billing information to identify discrepancies.
Track authorization requirements and communicate outstanding issues to appropriate departments.
Coordinate and track agency, program, and provider credentialing and recredentialing activities.
Collect, review, and organize credentialing documentation; monitor applications, effective and expiration dates, outstanding requirements, and payer responses.
Assist with credentialing submissions to public and private insurance entities and maintain accurate records and renewal deadlines.
Support credentialing requirements for new programs, services, and providers.
Collect, verify, organize, and maintain compliance-related data and tracking systems.
Prepare routine reports on audit results, documentation deficiencies, insurance authorizations, credentialing, claims-related issues, and corrective actions.
Reconcile records and reports to verify accuracy and identify discrepancies.
Track compliance deadlines, renewals, corrective actions, and required submissions.
Identify trends, process gaps, and improvement opportunities and communicate recommendations to the Compliance Manager.
Assist with implementing and monitoring approved quality improvement initiatives.
Research regulatory, contractual, and payer requirements as assigned, and monitor assigned regulatory updates.
Maintain applicable compliance guidance and resources and assist with updating compliance tools, forms, checklists, and procedures following approved changes.
Gather information to support development and revision of policies and procedures and assist with implementing approved changes.
Assist with developing and delivering compliance-related training and educational materials.
Provide routine guidance to staff on established documentation, authorization, credentialing, and compliance procedures.
Coordinate requests for missing or incomplete documentation and follow up to support timely completion.
Collaborate with program leadership, Finance, Admissions, Human Resources, and other departments to address compliance needs.
Escalate significant, recurring, or unresolved compliance concerns to the Compliance Manager.