ACA Program Integrity Coordinator - Hybrid

Location: AZ Blue Phoenix, AZ 85021

Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions.

At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. While the majority of our employees are hybrid, the following classifications drive our current minimum onsite requirements:

Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week

Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week

Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month

Onsite: daily onsite requirement based on the essential functions of the job

Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building

Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week.

This position is hybrid within the state of AZ only. This hybrid work opportunity requires residency, and work to be performed, within the State of Arizona.

PURPOSE OF THE JOB

TheACAProgramIntegrityCoordinatorservesasasubjectmatterexpertforAffordableCareAct(ACA)programintegrity,compliancedeliverables,vendorperformance,andservicedeliveryoversight.

This position manages day-to-day vendor relationships, monitors regulatory and contractual performance,supportsannualQualifiedHealthPlan(QHP)andOpenEnrollmentreadinessactivities,validatesvendorfinancialactivity,andpartnerswithinternalstakeholderstoidentifyrisks,resolveissues,anddriveaccountableprocessimprovement.

REQUIREDQUALIFICATIONS

RequiredWorkExperience

• Fiveyearsofexperienceinhealthinsuranceback-officeoperations,qualityandcomplianceprograms,productdevelopment,vendormanagement,financialoperations,businessoperations,orarelatedfield.
• Threeyearsofexperienceleadingprocessimprovementordesigningandimplementingbusinessprocessesaccordingtocustomeroroperationalspecifications.
• Experienceworkingwithvendorinvoices,budgets,purchaseorders,financialtracking,vendorperformance,contracts,orserviceagreements.
• Experiencesupportingcompliance,privacy,governmentprograms,healthcareoperations,legalmatters,orregulatorydeliverables.

RequiredEducation

Bachelor’sdegreeinBusiness,Finance,HealthcareOperations,HealthcareAdministration,orarelatedfield.

RequiredLicenses

None.

RequiredCertifications

None.

PREFERREDQUALIFICATIONS

PreferredWorkExperience

• Experience inhealthplanprogrammanagement,URACorNCQArequirements,delegationoversight,senior-levelprojectmanagement,outsourcedvendororbusinessprocessoutsourcingenvironments,orexternalrelationshipmanagement.
• Experiencewithfinancialsystems,invoicingtools,vendormanagementplatforms,service-levelagreementtracking,performancereporting,ordashboarddevelopment.
• SpecializedtrainingorcertificationfromtheBlueCrossBlueShieldAssociation.
• Advancedcomplianceorlegaltraining.
• ProjectManagementProfessionalcertificationorProfessionalBusinessAnalysiscertification.

PreferredEducation

Master’sdegreeinBusiness,Finance,HealthcareOperations,HealthcareAdministration,orarelatedfield.

PreferredLicenses

None.

PreferredCertifications

None.

ESSENTIALJOBFUNCTIONSANDRESPONSIBILITIES

ACAIndividualSegmentSupport

• MaintaincurrentknowledgeofACA,CentersforMedicare&MedicaidServices,FederallyFacilitatedExchange,andQualifiedHealthPlanregulatoryrequirements.
• Reviewregulatoryguidance,operatingmanuals,trainingmaterials,andprogramupdates,andtranslaterequirementsintoclearactionsforinternalownersandbusinesspartners.
• Identifygapsinpolicies,procedures,controls,anddocumentation.
• Draftorupdatematerialsthatsupportregulatorycomplianceandoperationalconsistency.
• Coordinateauditresponses,correctiveactionplans,andsupportingdocumentationforinternal,regulatory,andvendor-relatedauditobligations.
• Conductresearch,analysis,datagathering,andissueinvestigationtosupportregulatorydeliverablesandleadershipdecisions.

VendorRelationshipandPerformanceManagement

• Serveastheprimaryday-to-dayliaisonforassignedACAvendorrelationshipsandvendor-supportedproductsorservices.
• Maintaindocumentationthatclearlydefinesvendorcontractobjectives,deliverables,scope,roles,responsibilities,resources,performanceexpectations,andissueownership.
• Monitorvendorperformanceagainstregulatoryrequirements,contractualcommitments,serviceexpectations,andservice-levelagreements.
• Developandmaintainvendorperformancedashboards,scorecards,issuelogs,action-itemtrackers,andrecurringleadershipreports.
• Engagevendorsandcross-functionalresourcestoresolveoperationalissues,escalateconstraintsorrisks,anddrivetimelyremediation.

FinancialOversightandContractSupport

• Manageandtrackvendorpurchaseorderstoensurealignmentwithapprovedscopesofwork,budgets,contracts,anddeliveredservices.
• Review,validate,reconcile,andfacilitatethetimelyprocessingofvendorinvoices.
• Identifyandresolveinvoicediscrepanciesinpartnershipwithvendorsandinternalstakeholders.
• Trackvendorspendingagainstbudgets,forecasts,actualactivity,credits,penalties,recoveries,andotherfinancialimpacts.
• Identifycost-savingopportunitiesthroughinvoicevalidation,utilizationreview,performanceinsights,andcontractaccountability.

Readiness,Projects,andProcessImprovement

• LeadorsupportannualQualifiedHealthPlanfiling,OpenEnrollmentreadiness,vendorreadinessplanning,testingstrategies,andrelatedleadershipstatusreporting.
• Coordinatemultidisciplinaryworkacrossinternalbusinessareas,vendors,compliance,legal,product,technology,andoperationalstakeholders.
• Contributetobusinessrequirements,userstories,testscripts,production-readinessvalidation,andfinalbusinessapprovalforvendor-impactingsolutions,asassigned.
• Leadorsupportprojectmanagementactivities,meetingfacilitation,agendadevelopment,pre-readdistribution,meetingminutes,andaction-itemfollow-up.
• Analyzeperformancetrends,rootcauses,businessimpacts,andoperationalriskstorecommendcorrectiveactionsandsustainableprocessimprovements.

Reporting,Communication,andStakeholderSupport

• Provideregularreportsandconsultationtomanagementregardingvendorperformance,financialperformance,operationalrisks,andremediationprogress.
• Facilitateeducationandcommunicationforvendors,internalstakeholders,andbusinesspartnersregardingregulatorychanges,vendorprocesses,complianceexpectations,andoperationalimpacts.
• Cultivateeffectiveworkingrelationshipswithvendors,internalstakeholders,leadership,andcross-functionalteamstosupportaccountabilityandregulatorconfidenceinorganizationalperformance.
• Mentorortrainteammembersonassignedprocesses,documentationstandards,tools,andregulatoryorvendor-managementexpectations.
• The position has an onsite expectation of 1 day per week and requires a full-time work schedule. Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements.
• Perform other duties as assigned

COMPETENCIES

REQUIREDCOMPETENCIES

RequiredJobSkills

• Intermediateskillinusingstandardofficeequipment,includingcopiers,scanners,faxmachines,andtelephones.
• IntermediatePCproficiency.
• Intermediateproficiencywithspreadsheet,database,presentation,andword-processingsoftware.

RequiredProfessionalCompetencies

• Advancedknowledgeofethical,corporate,orgovernmentcompliancerequirementsorHIPAAprivacyrequirements.
• Stronganalyticalskillsthatsupportindependentandeffectivedecision-making.
• Abilitytoprioritizetasksandmanagemultiplepriorities,includingworkperformedunderlimitedtimeconstraints.
• Perseverancewhenfacingresistanceorsetbacks.
• Effectiveinterpersonalskillsandtheabilitytomaintainpositiveworkingrelationships.
• Strongverbalandwrittencommunicationskills.
• Abilitytointeractprofessionallywithexecutives,managers,subjectmatterexperts,andotherdiversestakeholders.
• Abilitytocreateanddeliveremployeeeducationaboutcomplexgovernment,corporatecompliance,privacy,andethicalissuesinanunderstandablemanner.
• Abilitytomaintainconfidentialityandprotectprivateinformation.
• Abilitytogeneratereportsfromavailabledataandmakeinformeddecisionsbasedonreportedresults.

RequiredLeadershipCompetencies

Abilitytotakeappropriate,informedrisksusingavailabledata.

Abilitytobuildsynergywithinadiverseteamoperatinginachangingenvironment.

PREFERREDCOMPETENCIES

PreferredJobSkills

• Advancedskillinusingstandardofficeequipment,includingcopiers,scanners,faxmachines,andtelephones.
• AdvancedPCproficiency.
• Advancedproficiencywithspreadsheet,database,presentation,andword-processingsoftware.

PreferredProfessionalCompetencies

Expertknowledgeofethical,government,orcorporatecompliancerequirementsorHIPAAprivacyrequirements.

Abilitytoworkwithambiguousorconflictinginformationwhileremainingfocusedontheintendedoutcome.

PreferredLeadershipCompetencies

Nonespecified.

#LI-AB1

Our Commitment

AZ Blue does not discriminate in hiring or employment on the basis of race, ethnicity, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, protected veteran status or any other protected group.

Thank you for your interest in Blue Cross Blue Shield of Arizona. For more information on our company, see azblue.com. If interested in this position, please apply.