Astrana Health

Network Operations

• Support provider network operations, including provider onboarding, terminations, demographic updates, and maintenance of provider records
• Coordinate provider-related activities across Contracting, Credentialing, Claims, Provider Relations, and other internal teams
• Serve as a primary point of contact for provider operational inquiries, network status questions, and administrative support needs
• Investigate, track, and resolve provider issues related to claims, reimbursement, EDI rejections, network participation, and operational processes
• Maintain accurate provider records, documentation, tracking logs, and operational workflows
• Assist with provider directory validation, audits, regulatory reporting, and data accuracy initiatives
• Compile and distribute operational reports related to provider network activities and performance
• Collaborate with internal departments and field-based network teams to support provider onboarding, education, and operational readiness
• Participate in process improvement initiatives designed to enhance provider experience, operational efficiency, and data quality
• Support health plan, regulatory, and organizational compliance requirements, including audit preparation and readiness activities

Provider Network Operations Representative

Associate

• Serve as an active member of a small, elite “SWAT” team to accelerate critical initiatives and unblock execution across Astrana
• Partner with executive leadership to advance CEO-priority initiatives from concept through execution
• Translate ambiguous, high-stakes priorities into structured plans, milestones, and measurable outcomes
• Coordinate alignment, accountability, and momentum across teams on critical cross-functional initiatives
• Identify operational gaps, process inefficiencies, and organizational friction points and design scalable solutions
• Partner with clinical, operational, and technical teams to identify, pilot, and scale AI-enabled solutions
• Advise senior leaders by surfacing risks, opportunities, and recommendations
• Build durable processes, frameworks, and talent that raise performance across functions
• Shape the vision, innovation agenda, and AI-enabled roadmap
• Lead delivery of high-impact initiatives, including diving into data, building dashboard applications, and developing prototypes

Associate / Senior Associate – Office of the CEO

Quality Specialist

• Build and maintain strong relationships with provider offices and clinic leadership.
• Conduct onsite and virtual provider outreach visits to review quality performance metrics, identify improvement opportunities, and retrieve relevant care gap closure data/records.
• Collaborate with assigned provider offices and health plans to improve documentation, coding accuracy, and care gap closure.
• Collect, review, and validate medical records to ensure accuracy and completeness for reporting purposes.
• Educate providers and office staff on quality measures, documentation standards, coding requirements, and best practices.
• Support monthly supplemental data submission, file preparation, and verification of compliant coding.
• Work with internal teams and vendors to validate, reconcile, and audit HEDIS records to ensure completeness and accuracy.
• Assist in developing QI initiatives such as outreach campaigns, provider education, and workflow optimization.
• Assist practices with workflow optimization, patient outreach strategies, and quality improvement interventions.
• Serve as a quality performance resource to assigned health plan partners, provider groups, clinics, and MSOs, providing and presenting HEDIS performance scorecards monthly.
• Monitor HEDIS progress dashboards and address data gaps prior to final submission.
• Prepare reports, scorecards, and presentations for leadership review.
• Obtain data needed for Primary Source Verification audits from health plans and vendors and ensure timely submission.
• Act as a subject matter expert on CMS, HEDIS, NCQA, HIPAA, and health plan standards.
• Conduct comprehensive training for PCPs and specialists on Quality Measures, HEDIS and CMS Star Ratings, Performance-Based Incentive Programs, Data Accuracy and Documentation Standards.
• Perform additional duties and projects assigned.

Quality Care Improvement Specialist

Director

• Design and oversee provider contracting strategies that align with organizational goals for growth, compliance, and cost-effectiveness
• Act as a thought leader, providing executive-level guidance on payer and provider contracting initiatives
• Direct and ensure proper administration of Division of Financial Responsibility (DOFRs), contract amendments, RFPs, and CAPs arising from Health Plans
• Oversee project management of all payer and provider contracting initiatives, ensuring execution within timelines and compliance requirements
• Lead delegation oversight and compliance reviews to minimize risk exposure, sanctions, and financial penalties
• Interpret and assess contractual risk in provider-facing and payer-facing agreements, leading high-stakes, time-sensitive negotiations
• Ensure contracts are structured to optimize reimbursement, protect the organization’s interests, and enhance provider relationships
• Establish and maintain policies and processes that streamline contract review, approval, and execution across the enterprise
• Partner with Claims, Configuration, Business Development, and Data Management teams to align operational processes with contracting strategies
• Drive root-cause solutions to systemic issues affecting contract performance or compliance
• Provide executive-level reports and recommendations to senior leadership on network adequacy, financial impact, and strategic opportunities
• Provide direction, coaching, and mentorship to Payer Relations Associates and contracting team members
• Efficiently delegate and coordinate workflow of contracts and health plan communications across the department
• Build organizational capability through continuous improvement, training, and development of team members
• Other duties as assigned

Senior Director – Provider Contracting

Medical Billing and Coding

• Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company
• Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC)
• Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines
• Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation
• Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing
• Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements.
• Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
• Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work.
• Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager.
• May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I
• Other duties as assigned.

Risk Adjustment Coding Specialist II

• Leads contract negotiations, as assigned, including risk-based agreements, fee-for-service negotiations, pay for performance programs, and ACO agreements with health plans
• Manages contractual relationships with payers and internal stakeholders
• Reviews health plan contract language and is familiar with payor, medical group/IPA, and hospital/ancillary contract language and reimbursement mechanisms
• Circulates draft contract terms/language to various internal departments for review & approval
• Applies knowledge of healthcare delivery system, IPA operations, managed care, healthcare laws in assisting with the development of contracting strategies
• Answers and/or resolves inquiries from health plans or internal departments in a timely manner
• Establishes good working relationships with health plan representatives and internal teams
• Develops tools (e.g., dashboards, grids, tables, summaries) to provide organizational leadership key contract data
• Utilizes applicable financial tools and reports to evaluate performance of current contracts
• Interacts and consults with Network Pricing team to evaluate different financial arrangements and recommend applicable payment methodologies
• Ensures compliance and consistent contracting across the enterprise.
• Manages various ad-hoc project requests with short turnaround time.
• Performs other duties as assigned.

Senior Director – Payer Contracting

Full-stack Engineer

• Design, test, deploy, improve, and maintain software that will be used internally at Astrana Health, and externally by physicians and patients
• Work cross-functionally with an agile team including Product, UX/Design, Engineers, and QA to execute mission-critical projects
• Suggest and drive improvement on all parts of the stack and internal development processes
• Manage project requirements, priorities, and deliverable timelines effectively
• Help mentor, coach, and develop junior members of our development team
• Technology Stack: Python, React, Javascript, SQL

Senior Software Engineer

Engineer

• You will embed directly within clinical, operations, and market teams and build systems that change how care is delivered and how the business performs.
• In a given month, you might:
• - Build an AI-driven tool to help care teams prioritize high-risk patients
• - Automate a workflow that is currently manual and impacting revenue or cost
• - Deploy an LLM-based system on top of messy clinical or claims data
• - Create internal tools that providers and operators rely on every day
• This role is about shipping real systems that work in the real world - not prototypes or isolated experiments.

Forward Deployed Engineer

Bilingual

• Conduct outreach to members with specified clinical gaps to help coordinate care and gap closure activities
• Schedule appointments for patients with the internal team and/or external provider offices
• Manage work through multiple portals required to access all relevant patient data
• Conduct outreach to provider offices in efforts to help patients schedule appointments, relay relevant health information, or obtain medical records
• Manage sms and email queues as assigned for incoming and outgoing patient communication
• Able to communicate with members in a language with or without the use of translation services
• Manage basic office functions such as faxing, voicemail, and mail
• Able to accurately enter patient data into relevant platforms and document outcomes in a clear and concise manner
• Able to educate patients on basic healthcare terminology and topics
• Pre-visit prep: assist with confirmation calls, rescheduling, and chart prep
• Post-visit work: assist in closing out any visit orders, such as referrals, faxing of notes, sending lab referrals, etc
• Assist patients in completing health questionnaires and documenting responses within EMR and/or designated platform.
• Maintain all patient data in compliance with the organization’s PHI practices and following Health Insurance Portability and Accountability Act (HIPAA) standards
• Other duties as assigned

Health Navigator, Bilingual Spanish

Coach

• Serve as a strategic advisor to provider practices, assessing clinical, operational, and financial performance and identifying opportunities for improvement
• Exercise independent judgment in prioritizing practice engagements and determining the most effective intervention strategies based on performance data and business impact
• Develop and lead execution of customized transformation plans to improve quality metrics, operational workflows, and financial outcomes
• Lead the design and implementation of workflow redesign initiatives, including EHR optimization, clinical documentation, and billing practices
• Diagnose root causes of quality and financial underperformance and develop targeted, data-driven solutions
• Provide guidance to providers and care teams to support adoption of optimized workflows and sustainable operational improvements
• Analyze and interpret complex performance data, including HEDIS, pay-for-performance metrics, and medical cost trends, to inform strategic recommendations
• Translate data insights into actionable performance improvement strategies tailored to individual practices and market needs
• Monitor progress against established goals and adjust strategies as needed to ensure performance targets are achieved
• Partner with internal stakeholders across Market Operations, Quality, and Population Health to ensure alignment on performance improvement initiatives
• Influence provider and practice-level decision-making through data-driven insights, education, and consultative engagement
• Serve as a key liaison between provider practices and organizational leadership to escalate risks, share insights, and drive alignment
• Identify trends and systemic opportunities across practices to inform broader market-level or enterprise performance strategies
• Contribute to the development of best practices, tools, and frameworks that enhance practice transformation efforts across the network
• Support special projects and strategic initiatives aligned with value-based care performance goals

Practice Transformation Coach

Supervisor

• Develop data structure and software applications
• Improve software platforms and systems to support business needs
• Design, test, deploy, improve, and maintain software used internally and externally
• Apply expertise on emerging or existing massive data to create and scale insights
• Develop large-scale models to enhance company efficiency
• Troubleshoot, debug, and upgrade distributed systems
• Produce specifications and determine operational feasibility
• Collaborate with functional teams to integrate software applications
• Manage project requirements and deliverable timelines
• Supervise EDI Analyst I & II
• Telecommuting permitted from within the U.S.