Astrana Health

Accountant

• Oversees deposits of cash on time while keeping accurate accounting records
• Keeps the manager up to date on all relevant and appropriate matters as it pertains to his/her position
• Prepares monthly journal entries and maintains complete records of these transactions
• Reconciles bank statements and keeps an accurate running total of cash on hand
• Ensures monthly balance sheet account reconciliations are prepared timely and accurately
• Compile and analyze financial information to prepare financial statements including monthly and quarterly management reports in accordance to U.S. GAAP
• Oversees accurate and appropriate recording and analysis of revenues and expenses and ensure financial records are maintained in compliance with accepted policies and procedures
• Ensures accurate and timely monthly, quarterly and year-end close processes making certain all financial reporting deadlines are met
• Assists in preparation and submission of quarterly and annual reports as required by Department of Managed Health Care’s agreement
• Submits quarterly and annual financial reports to the health plans
• Supports the budget and forecast activities; including fluxes preparation against actual results
• Prepares for financial audit and coordinate the audit process including working with external auditors and health plans
• Ensures compliance with relevant laws and regulations and integrity of financial data
• Assists with ad-hoc procedures and tasks as requested from management

Senior Accountant, Healthcare

Community Manager

• Build and sustain strong relationships with community-based organizations to promote membership growth and retention.
• Lead community engagement initiatives that enhance the organization’s visibility and trust within diverse communities.
• Plan, organize, and execute community events, including:
• Senior expos and health fairs
• Doc Talks/Lunch & Learns
• Sponsorships
• Astrana hosted events (fun social events)
• SWAG Center Activities
• Track lead generation from grassroots activities and ensure timely follow-up to convert leads into members.
• Maintain monthly event invite email blast through Campaign Monitor or another platform.
• Collaborate with team to develop and implement outreach and marketing strategies tailored to senior population.

Community Engagement Specialist

Manager

• Provider Performance Monitoring & Engagement
• Monitor overall provider performance utilizing performance reports including quality, utilization, referral management, and risk, as well as provider engagement activities and team feedback.
• Use data insights to prioritize provider engagements and determine the most effective intervention strategies based on performance outcomes and business impact.
• Develop provider profiles and insights to identify key areas in workflows that can be improved, including AWV processes, EMR template design, and scheduling practices. Risk Adjustment & HCC Improvement
• Understand, develop, and implement HCC (Hierarchical Condition Category) improvement activities to support accurate risk adjustment and financial performance.
• Implement provider change management activities, including organizing and structuring provider education sessions and developing tools to enhance clinical documentation and coding accuracy.
• Align in-office activities to support HCC capture and ensure optimal risk adjustment performance across the provider network.
• Quality Improvement & Program Development
• Understand, develop, and implement quality improvement activities such as colorectal screening programs, education webinars, EMR improvement initiatives, and medication management programs (e.g., pill delivery programs).
• Align quality improvement efforts through market vendors and internal stakeholders to ensure coordinated execution across the network.
• Lead provider education and engagement strategies designed to improve HEDIS, Stars, and other quality performance metrics.
• Data Analysis & Performance Reporting
• Analyze claims data, performance reports, and utilization reports using Excel and available technology platforms to identify trends and performance opportunities.
• Translate complex data insights into actionable performance improvement strategies tailored to individual markets and provider needs.
• Monitor progress against established goals and adjust strategies as needed to ensure performance targets are achieved.
• Network Development, Provider Relations & Market Growth
• Use data to identify and establish relationships with key specialty groups to improve patient care and lower cost.
• Establish Joint Operating Committees (JOCs) with network partners to identify opportunities for improvement through data analysis and referral management with PCPs.
• Serve as a key liaison between provider practices and organizational leadership to escalate risks, share insights, and drive strategic alignment.
• Lead network and provider growth initiatives aligned with market expansion priorities, identifying and onboarding new provider partners to strengthen Astrana’s value-based care network.
• Collaborate with Market Operations and network development teams to assess geographic gaps, evaluate provider opportunities, and execute strategies that expand market presence and increase attributed patient populations.
• Support the integration of newly onboarded providers into performance improvement programs, ensuring alignment with quality, utilization, and financial goals from the point of engagement.
• Goal Setting & Cross-Functional Leadership
• Develop long-term and short-term goals with tracking metrics; establish role-based goals that align with Astrana organizational objectives.
• Work with team members to identify key activities that directly impact entity goals, and collaborate with ACO management to set specific performance targets for quality or financial improvement.
• Partner with internal stakeholders across Market Operations, Quality, and Population Health to ensure alignment on performance improvement initiatives.
• Manage multiple large, cross-functional projects simultaneously, ensuring timely delivery and measurable impact.

Manager – Market Performance & Improvement

Accounting Manager

• Drive process improvement and overall accounting team efficiencies
• Responsible for all aspects of accounting including accounts receivable, revenue and expense accruals, bank/account reconciliations, etc
• Ensures monthly, quarterly, and year-end close are completed timely and accurately for regulation requirements
• Oversees accurate and appropriate recording journal entries and ensure financial records are maintained in compliance with accepted policies and procedures
• Reviews monthly financial statements and fluxes
• Keeps Controller and executives up to date on all relevant and appropriate matters as it pertains to their position
• Monitors and supports taxation requirements for provision, as well as Form 1099 filings
• Collects / analyzes financial information and develops and maintains financial databases
• Ensures compliance with relevant laws and regulations and integrity of financial data
• Assists with ad-hoc procedures and tasks as requested from upper management

Accounting Supervisor

Senior Accountant

Analyst

• Analyze program performance data including cost, utilization, risk adjustment, medical claims, and quality metrics.
• Use SQL and Python to query and manipulate large healthcare datasets to identify trends, anomalies, and improvement opportunities.
• Develop dashboards, reports, and scorecards using tools like Tableau, Power BI, or Excel to communicate performance to internal and external stakeholders.
• Conduct root-cause analyses and evaluate ROI on initiatives aimed at closing gaps and optimizing outcomes.
• Support the design, tracking, and evaluation of initiatives aligned with performance programs focused on quality improvement and cost containment.
• Translate regulatory and contractual requirements into data queries and programmatic deliverables.
• Forecast performance and monitor key performance indicators (KPIs) across value-based contracts.
• Stay current on evolving quality measurement methodologies and value-based care structures.
• Partner with departments including Population Health, Quality, Clinical Programs, Finance, and IT to align strategies and ensure consistency across data sources and reporting.
• Serve as a key translator between technical findings and operational strategy—ensuring insights are actionable for clinical and non-technical audiences.
• Ensure data quality through validation and standardization of reporting sources.
• Contribute to enhancements in analytics methodologies and reporting frameworks.
• Stay up to date with healthcare analytics best practices and regulatory trends.

Quality Analyst

Operations

• Responsible for designing, developing, and maintaining reporting databases to support the team's business requirements and continually improve data acquisition and reporting methods.
• Periodically reviewing and enhancing database processes and functionalities.
• Developing internal systems and exception reports.
• Ensuring timely and accurate credentialing, contracting, and provider information management systems.
• Analyzing complex data, developing reporting solutions, and supporting operational strategies that impact provider networks and contracting outcomes.

Provider Contracting Operations Analyst

• Comply with Case Management Department’s policies and procedures
• 95 - 100% compliance with Utilization Management health plan delegation standards for Case Management
• Utilize Milliman Care Guidelines criteria for appropriateness of transition to care by level of skilled needs and acute rehab for post discharge plan
• Collaborating with Hospitalists, case managers, and discharge planners to establish discharge plans at time of admission
• Responsible for coordinating the required initial and concurrent reviews based on the review of medical records received and daily accurate reporting of all inpatient admissions to Medical Director and Manager and/ or Supervisor of Case Management Department
• Review of medical records and/or other documentation to determine medical necessity, appropriateness and level of care utilizing Milliman Care and other appropriate Guidelines
• Assess, plan, implement, coordinate, monitor, and evaluate all options and services with the goal of reducing hospital readmission • Attends/coordinates Case Management meetings on and off-site as necessary
• Interacts with the providers or members as appropriate to communicate determination outcomes in compliance with state, federal and accreditation requirements
• Attend to provider and interdepartmental calls in accordance with exceptional customer service
• Maintain good relationships with health plans, hospitals and medical directors. Resolve problems that arise with any IPA medical directors
• Report to Manager and/or Supervisor of Case Management on activities and/or problems occurring throughout the day
• Available for Hospital on site Case Management
• Other duties as assigned

Case Manager, LVN

Medical Billing and Coding

• Extract diagnosis codes (specifically HCC codes) and CPT codes from hospital records.
• Reviews medical records to determine if specific disease conditions were correctly reported based on documentation.
• Follow the coding guidelines.
• Ensures project activities are in compliance with applicable coding guidelines, government and federal regulations.
• Regularly and consistently meet quality and productivity standards established by management.
• Maintain ongoing communication with management regarding coding workload, turnaround time expectations and deliverables.
• Additional duties as necessary to meet the obligations to our providers.
• Maintains at least 95% accuracy in all coding projects by researching literature and attending professional seminars, workshops and conference as required by AAPC and/or AHIMA to maintain professional certification(s).

Medical Coder

Actuary

• Reserving: Develop and maintain actuarial models to estimate liabilities for Incurred but Not Paid (IBNP) claims across all lines of business (Medicare, Medicaid, and Commercial).
• Financial Planning and Analysis: Support budgeting and forecasting by maintaining and improving P&L models and forecasting tools, as well as developing new tools to identify emerging trends and improve predictive accuracy.
• Cost Trend Evaluation: Manage the Actuarial Trend Model used in operational and financial decision-making and analyze healthcare utilization patterns and cost trends to identify areas for improvement and opportunities for cost savings.
• Actuarial Studies: Develop actuarial studies relating to items such as seasonality, high claim predictive modeling, trend, and inventory levels.
• Audit and Reporting: Maintain, develop, and create ad hoc audit documentation in support of a public company, adhering to SOX compliance standards.
• Infrastructure Development: Build robust analytical infrastructure, including comprehensive reports and dashboards, to monitor expense experience.
• Cross-Functional Collaboration: Work closely with teams across ACO, Analytics, Data, Finance, M&A, Contracting, Medical Economics, and Operations.
• Ad Hoc Analysis: Support a fast-growing company with diverse actuarial projects and requests as they arise.
• Other duties as assigned.

Senior Analyst – Actuary

• We are seeking a highly skilled and execution-focused Manager of Advanced Analytics to help shape and deliver our analytics strategy and roadmap.
• This role is hands-on and influential, focused on designing and implementing scalable data solutions, building advanced BI capabilities, and enabling actionable insights across risk adjustment, clinical operations, quality, compliance, and cost management.
• The ideal candidate combines strong technical expertise with the ability to guide and mentor team members while collaborating closely with cross-functional stakeholders.
• You will partner with data analysts, data scientists, technology teams, and business leaders to design, implement, and optimize advanced analytics solutions that support internal and external clients.
• With over a million managed lives and terabytes of healthcare data generated, your contributions will be critical to driving data-driven decision making and improving patient outcomes.

Manager – Advanced Analytics

• Oversee and maintain a comprehensive contract inventory, ensuring accuracy and accessibility for internal stakeholders.
• Manage recruitment of regional and national providers and vendors in alignment with corporate, health plan, and state guidelines.
• Assist with negotiations of provider, payor and vendor contracts, oversee implementations, and cultivate ongoing relationships.
• Define, initiate, and manage operational reporting, including establishing goals, performance metrics, and process improvements.
• Lead contract modifications, coordinating with local health plans, legal teams, and other internal departments.
• Develop and implement strategies to enhance contracting efficiency, standardization, and compliance.
• Initiate and facilitate meetings with health plans and corporate teams, including executive leadership, to review vendor and provider agreement performance, data scorecards, and partnership strategies.
• Support project management initiatives within the department, driving process improvements, system implementations, and operational efficiencies.
• Other duties as assigned.

Senior Manager – Provider Contracting

• Responsible for quality and performance metrics of processing teams that are assigned
• Collaborate with other Teams as directed that are newly contracted and need to be implemented
• Manage claims inventory to minimize claims turnaround times and ensure contractual SLAs are met
• Drive continuous improvement efforts to improve claims quality and efficiency
• Resolve processing/system issues within assigned department and across all IPAs
• Prioritize work volumes on a daily basis
• Oversee status of production in assigned department to ensure production and quality goals are being met
• Analyze impact of new implementations on assigned department and reallocate staff duties as necessary
• Onboard a large IPA that has global risk to ensure a successful implementation addressing and working with run out for the group, ensure accuracy, timeliness and meeting all regulatory requirements for a smooth transition
• Training off-shore staff to take on a large IPA that is completely new to the organization and ensuring that there are no issues of non-compliance inaccuracies or problems that are brought to the attention of Astrana-This is a huge lift considering the volume of membership, claims run-out responsibility and ensuring there is no lapse in their claims adjudications and payment processes moving forward
• Utilize claims management systems to provide reports and analysis to management on a regular basis
• Develop team members to ensure accountability for achievement of departmental goals and objectives
• Update and facilitate implementation of process and workflow modifications to improve operational efficiency
• Educate and train claims employees on the overall claims process and best practices for successful outcomes
• Address claim inquiries and claim payments by sensitive providers and members
• JOC meetings-attendance and corrective action response when required
• System updates maintaining the integrity of the Claims Payment Database; working inter-departmentally with other managers
• Off-site Seminars IE: E-Z Cap and HMO Regulatory training.
• High level grievances or claim reconsideration request for reimbursable claim reviews as needed
• Evaluate trends in compliance findings to determine root cause and work with Director on remediations such as IDNs, EOBs, and all other findings that need to be addressed with the claims teams or Senior Leadership
• Address non-compliance to Departmental standards with the examiners to include disciplinary actions, PIPs, Training plans and coaching
• Job Descriptions- format a standardized Claim Department Organizational Chart outlining performance responsibilities and requirements for each position
• Performance evaluation- monitors track and documents the annual performance evaluation of each Claim Department staff
• Recruit monitor, and document the attendance, production and work quality of Claim Department staff to include employee counseling and/or termination in accordance with HRIS Guidelines
• Staff analysis and growth potential
• Maintain open and effective channels of communication between staff and management
• Represent DMHC Regulatory and CMS Claims Payment Compliance issues at Management Meetings and with the Executive Board
• Using all tools available ( IE: Industry Communications, Seminars, Internet, Professional Networking) to maintain the most current levels of understanding of trends, occurrences, ideology and law that will affect the operation, compliance and stability of the Claims Department and of Astrana
• Communicate this information timely and effectively to both Claims Department Staff and to Management
• Maintains the strictest confidentially at all times
• Responsible for other miscellaneous assignments as requested by Management

Senior Manager – Claims

Medical Director

• Provide physician oversight and final determination for outpatient utilization management activities, including prior authorizations, retrospective reviews, and appeals.
• Ensure medical necessity and appropriateness of outpatient services such as specialty referrals, diagnostics, imaging, DME, therapies, and procedures.
• Support compliance with delegated health plan requirements, regulatory standards, and accreditation guidelines.
• Conduct peer‑to‑peer reviews and outpatient physician education to improve documentation, guideline adherence, and appropriate utilization.
• Partner with Outpatient Medical Directors, Population Health, and UM nursing teams to align utilization decisions with Astrana’s value‑based care strategy.
• Identify outpatient utilization trends, leakage, and variation; recommend clinical strategies to improve cost efficiency and quality outcomes.
• Serve as clinical liaison with health plans and external vendors on outpatient UM‑related matters.

Senior Accountant, Healthcare

Community Engagement Specialist

Manager – Market Performance & Improvement

Accounting Supervisor

Senior Accountant

Senior Accountant

Quality Analyst

Provider Contracting Operations Analyst

Case Manager, LVN

Medical Coder

Senior Analyst – Actuary

Manager – Advanced Analytics

Senior Manager – Provider Contracting

Senior Manager – Claims

Medical Director – Utilization Management