ACA Program Integrity Coordinator - Hybrid

Blue Cross Blue Shield of Arizona•Phoenix, AZ

1d•Hybrid

About The Position

The ACA Program Integrity Coordinator serves as a subject matter expert for Affordable Care Act (ACA) program integrity, compliance deliverables, vendor performance, and service delivery oversight. This position manages day-to-day vendor relationships, monitors regulatory and contractual performance, supports annual Qualified Health Plan (QHP) and Open Enrollment readiness activities, validates vendor financial activity, and partners with internal stakeholders to identify risks, resolve issues, and drive accountable process improvement.

Requirements

Five years of experience in health insurance back-office operations, quality and compliance programs, product development, vendor management, financial operations, business operations, or a related field.
Three years of experience leading process improvement or designing and implementing business processes according to customer or operational specifications.
Experience working with vendor invoices, budgets, purchase orders, financial tracking, vendor performance, contracts, or service agreements.
Experience supporting compliance, privacy, government programs, healthcare operations, legal matters, or regulatory deliverables.
Bachelor’s degree in Business, Finance, Healthcare Operations, Healthcare Administration, or a related field.
Intermediate skill in using standard office equipment, including copiers, scanners, fax machines, and telephones.
Intermediate PC proficiency.
Intermediate proficiency with spreadsheet, database, presentation, and word-processing software.
Advanced knowledge of ethical, corporate, or government compliance requirements or HIPAA privacy requirements.
Strong analytical skills that support independent and effective decision-making.
Ability to prioritize tasks and manage multiple priorities, including work performed under limited time constraints.
Perseverance when facing resistance or setbacks.
Effective interpersonal skills and the ability to maintain positive working relationships.
Strong verbal and written communication skills.
Ability to interact professionally with executives, managers, subject matter experts, and other diverse stakeholders.
Ability to create and deliver employee education about complex government, corporate compliance, privacy, and ethical issues in an understandable manner.
Ability to maintain confidentiality and protect private information.
Ability to generate reports from available data and make informed decisions based on reported results.
Ability to take appropriate, informed risks using available data.
Ability to build synergy within a diverse team operating in a changing environment.

Nice To Haves

Experience in health plan program management, URAC or NCQA requirements, delegation oversight, senior-level project management, outsourced vendor or business process outsourcing environments, or external relationship management.
Experience with financial systems, invoicing tools, vendor management platforms, service-level agreement tracking, performance reporting, or dashboard development.
Specialized training or certification from the Blue Cross Blue Shield Association.
Advanced compliance or legal training.
Project Management Professional certification or Professional Business Analysis certification.
Master’s degree in Business, Finance, Healthcare Operations, Healthcare Administration, or a related field.
Advanced skill in using standard office equipment, including copiers, scanners, fax machines, and telephones.
Advanced PC proficiency.
Advanced proficiency with spreadsheet, database, presentation, and word-processing software.
Expert knowledge of ethical, government, or corporate compliance requirements or HIPAA privacy requirements.
Ability to work with ambiguous or conflicting information while remaining focused on the intended outcome.

Responsibilities

Maintain current knowledge of ACA, Centers for Medicare & Medicaid Services, Federally Facilitated Exchange, and Qualified Health Plan regulatory requirements.
Review regulatory guidance, operating manuals, training materials, and program updates, and translate requirements into clear actions for internal owners and business partners.
Identify gaps in policies, procedures, controls, and documentation.
Draft or update materials that support regulatory compliance and operational consistency.
Coordinate audit responses, corrective action plans, and supporting documentation for internal, regulatory, and vendor-related audit obligations.
Conduct research, analysis, data gathering, and issue investigation to support regulatory deliverables and leadership decisions.
Serve as the primary day-to-day liaison for assigned ACA vendor relationships and vendor-supported products or services.
Maintain documentation that clearly defines vendor contract objectives, deliverables, scope, roles, responsibilities, resources, performance expectations, and issue ownership.
Monitor vendor performance against regulatory requirements, contractual commitments, service expectations, and service-level agreements.
Develop and maintain vendor performance dashboards, scorecards, issue logs, action-item trackers, and recurring leadership reports.
Engage vendors and cross-functional resources to resolve operational issues, escalate constraints or risks, and drive timely remediation.
Manage and track vendor purchase orders to ensure alignment with approved scopes of work, budgets, contracts, and delivered services.
Review, validate, reconcile, and facilitate the timely processing of vendor invoices.
Identify and resolve invoice discrepancies in partnership with vendors and internal stakeholders.
Track vendor spending against budgets, forecasts, actual activity, credits, penalties, recoveries, and other financial impacts.
Identify cost-saving opportunities through invoice validation, utilization review, performance insights, and contract accountability.
Lead or support annual Qualified Health Plan filing, Open Enrollment readiness, vendor readiness planning, testing strategies, and related leadership status reporting.
Coordinate multidisciplinary work across internal business areas, vendors, compliance, legal, product, technology, and operational stakeholders.
Contribute to business requirements, user stories, test scripts, production-readiness validation, and final business approval for vendor-impacting solutions, as assigned.
Lead or support project management activities, meeting facilitation, agenda development, pre-read distribution, meeting minutes, and action-item follow-up.
Analyze performance trends, root causes, business impacts, and operational risks to recommend corrective actions and sustainable process improvements.
Provide regular reports and consultation to management regarding vendor performance, financial performance, operational risks, and remediation progress.
Facilitate education and communication for vendors, internal stakeholders, and business partners regarding regulatory changes, vendor processes, compliance expectations, and operational impacts.
Cultivate effective working relationships with vendors, internal stakeholders, leadership, and cross-functional teams to support accountability and regulator confidence in organizational performance.
Mentor or train team members on assigned processes, documentation standards, tools, and regulatory or vendor-management expectations.
Perform other duties as assigned