Astrana Health

Medical Director

• Serve as physician leader for inpatient clinical operations across assigned hospitals.
• Drive quality, safety, and patient outcomes aligned with Astrana Health’s value‑based and capitated risk programs.
• Partner with hospitalists, specialists, nursing leadership, and case management to optimize LOS, avoidable utilization, and transitions of care.
• Oversee physician performance, clinical compliance, and adherence to evidence‑based protocols and pathways.
• Collaborate with Population Health, Utilization Management, and Post‑Acute teams to reduce readmissions and total cost of care.
• Support payer and delegated risk requirements, including clinical documentation, medical necessity, and audits.
• Act as clinical liaison between Astrana Health, hospital partners, and community physicians.
• **What Success Looks Like**
• Improved inpatient quality and safety metrics.
• Reduced LOS, readmissions, and unnecessary utilization.
• Strong physician engagement and alignment with Astrana Health’s clinical and financial goals.
• Seamless care transitions across the continuum.

Inpatient Medical Director – SoCal

Learning and Development

• Assessing organizational learning needs.
• Designing and implementing effective learning solutions.
• Delivering training programs that support workforce capability, employee development, and organizational performance.
• Facilitating training across multiple formats and audiences.

Lead Trainer – Learning & Development

Human Resources

• Coordinate onboarding activities, including pre-employment screenings such as background checks, drug screening, physicals, onboarding tickets, new hire documentation, and Form I-9 completion in compliance with federal and state requirements
• Support on site and virtual new hire orientation to ensure a smooth and positive onboarding experience
• Assist with offboarding processes, including initiating exit procedures, coordinating final pay information, and partnering with Payroll, IT, and management to ensure timely system access termination
• Serve as a first point of contact for employee and candidate inquiries; respond to standard to moderately complex questions related to onboarding, payroll, benefits, HRIS transactions including ADP Workforce Now, policies, and general HR procedures
• Support employee job changes, transfers, and employee data updates within HR systems as assigned
• Assist with employment verifications, unemployment claims, child support notices, and responses to government or regulatory agencies under guidance
• Maintain accurate, timely, and audit ready employee records and documentation • Support audits, compliance activities, and reporting requests
• Partner with HR team members on assigned projects, process improvements, and system updates
• Perform other HR related duties as assigned

HR Coordinator

Support Engineer

• Provide prompt and effective first-level technical support for various IT incidents.
• Collaborate with internal technical support and engineering teams on projects and support cases.
• Handle incoming helpline calls and tickets, offering initial technical assistance before escalations.
• Convey intricate cases and project tasks to Tier II and/or III support teams.
• Offer field support in the absence of dedicated field support engineers.
• Participate in a rotation to provide after-hours on-call support, a mandatory requirement for all Tier I staff.
• Fulfill on-call duties by delivering remote assistance and support during the designated times.
• Proactively review event logs related to systems, networking, and security, contributing to the support team's effectiveness.
• Ensure compliance with SOX 404B and HIPAA rules and regulations as defined in policies.
• Maintain open communication about any issues with scheduled maintenance tasks to IT Management.
• Educate users on technologies, cybersecurity, and safeguarding company assets.

IT Support Analyst

General Counsel

• Serve as a primary legal owner for managed care and provider contracting
• Act as a first‑line legal decision‑maker for day-to-day operations in a high‑volume, high‑complexity environment
• Draft, review, and negotiate a high volume of healthcare‑related agreements
• Provide pragmatic, business‑oriented legal guidance that enables execution
• Partner closely with stakeholders across Network Development, Contracting, Operations, Finance, Compliance, and Executive Leadership
• Help structure complex arrangements that balance growth, operational realities, and legal risk
• Advise on California managed care and healthcare regulatory considerations
• Support innovative and evolving value‑based care and risk‑bearing structures
• Develop and refine templates, playbooks, and negotiation frameworks

Senior Counsel, Managed Care Operations

Risk

• Contact and collect medical records onsite from Provider’s offices or via EMR access documentation for coders/audits/sweeps retrieval
• Collect and summarize meeting minutes from the meeting.
• Coordinate office activities (such as scheduling meeting for internal/external and provider visit)
• Prepare reports for the meeting (weekly/monthly or quarterly, if needed)
• Distribute E-Fax
• Responding to emails and faxes specifically to the team
• Create/update monthly list for Active Members/Member Without Office Visit in IPA folder.
• Receive and organize data from external sources.
• Understand the principles of HIPAA and maintain confidentiality of patient health information.
• Understand the principles of Risk Adjustment based CMS standards.
• Communicate internally and externally as needed to gather necessary data.
• Attend provider and interdepartmental calls in accordance with exceptional customer service.
• Promotes a positive working relationship between NMM, IPAs, and health plan.
• Attend IPA and health plan meetings as required and respond to questions/inquiries in a timely manner.
• Performs duties in a professional manner, utilizing time and resources efficiently.
• Other duties as assigned

Risk Adjustment Coordinator

Financial Planning and Analysis

• Lead annual budgeting, monthly forecasting, and multi-year financial planning, including development of financial models for strategic and operational decision-making.
• Perform variance analysis and partner with business leaders to assess performance, identify drivers, and support operational planning.
• Oversee monthly financial reporting, dashboards, and executive presentations communicating business performance.
• Analyze results across business segments to identify trends, risks, and opportunities, delivering actionable insights to senior leadership.
• Lead ad hoc financial analyses to support strategic initiatives, operational improvements, and investment decisions.
• Develop advanced financial models and business cases, including ROI, sensitivity, scenario analysis, and time studies, in collaboration with cross-functional teams.
• Advance FP&A analytical capabilities through enhanced financial modeling, analytics, and reporting tools.
• Drive process improvements, automation, and data accuracy in partnership with data and technology teams.
• Provide leadership, mentorship, and oversight to FP&A team members while fostering analytical rigor and continuous improvement.
• Support professional development through coaching, project ownership, and exposure to strategic financial initiatives.

Manager – Financial Planning and Analysis

Compliance

• Coordinate and perform ongoing processes supporting various Compliance initiatives such as provider and vendor exclusion screening, operational approvals and library maintenance as well as general support of other compliance technology platforms as required. Assist with developing compliance and regulatory materials and/or training tools as needing to educate internal departments on new technology supporting federal and state regulatory changes and initiatives.
• Assist compliance team in maintaining incoming health plan updates related to IPA compliance program and contractual requirements and disseminate key information to lead teams internally, as needed. Maintain internal documentation to ensure compliance and regulatory changes/updates are logged for record keeping.
• Maintain documentation and prepare materials for Compliance Committee and other internal workgroups as it pertains to the Compliance Department.
• Assist Compliance team in tracking areas of compliance and regulatory vulnerability while assisting in documenting updates for audit submissions.
• Coordinate and maintain master audit calendar for all health plan audits/CAPs/Readiness preparation.
• Work collaboratively with all departments to follow up on audit items and ensure accuracy of information provided and timely submission, as needed.
• Assist Compliance team to track regulatory deadlines and submit various reports as it relates to other contractual requirements.
• Assist with tracking compliance of required policy changes when modifications are needed according to a regulatory update, health plan specific department audits, CAPs or Readiness. Assist with tracking updates to HIPAA policies and procedures for the Compliance Department.

Compliance Coordinator

Auditor

• As a member of Astrana Health’s Internal Audit department, the Sr. Internal Auditor is responsible for all aspects of the SOX 404 compliance process including assisting with annual planning, performing walkthroughs, and performing controls testing to evaluate the design and operating effectiveness of key internal controls over financial reporting (ICFR).
• Under the direction of the Manager – Internal Audit, the Sr. Internal Auditor leverages their understanding of internal control structures to assess key business processes that affect Astrana Health’s ability to fulfill its business objectives and strategic goals; as well as to evaluate compliance with policies, procedures, regulations and management objectives.
• Responsibilities will include assisting in defining control objectives, monitoring compliance efforts, and developing, implementing, and updating SOX documentation.
• Additional responsibilities involve conducting performance, operational, financial, and other compliance audit projects and providing consulting services to the organization’s management and staff.
• The Sr. Internal Auditor maintains all organizational and professional ethical standards and completes all internal audit work in compliance with the IIA’s *International Standards for the Professional Practice of Internal Auditing; and works independently under general supervision with latitude for initiative and independent judgment in the performance of their work.
• In addition to executing audits, the Sr. Internal Auditor will serve as an internal consultant to Astrana Health’s business process and control owners on the Company’s ICFR. Accordingly, this role is ideal for someone who is process oriented, enjoys working cross functionally, and can bring the “human” element to managing SOX compliance.

Senior Internal Auditor

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 I, Spanish Bilingual

Manager

• The Senior Claims Manager, Claims Delegation Oversight, is responsible for the management and oversight of all Claims Delegation Audits, including health plan and governing agencies audits, i.e., DMHC, CMS, and DHCS.
• This role will be responsible for the development and execution of department strategies, overall Audit program, Audit process optimization, and management, identifying and leveraging technology and data to improve the quality and minimizing process cost of Claims.
• The position alongside the leadership team will contribute to driving strategic planning, operational excellence, and accuracy of the claims process and ensure compliance with regulations and contract requirements for Medicare, Commercial Exchange, and Medicaid service lines.
• This position will contribute and influence overall Claims Delegation Oversight roadmap to ensure Claims Administrations are adhering to regulatory and internal guidelines as they apply to claims processing and adjudication.
• Working with the Department Director, Senior Manger will collaborate with other Astrana Health departments and personnel to develop strategies to identify, mitigate and optimize operational and financial gaps.

Senior Manager – Claims Delegation Audit

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

• Supervise, coach, and mentor Risk Adjustment Coding Specialists to ensure high-quality, compliant coding practices
• Serve as a resource for coders regarding ICD-10-CM, HCCs, CMS Risk Adjustment guidelines, and documentation standards
• Monitor individual and team productivity, accuracy, and quality metrics; provide ongoing feedback and corrective action as needed
• Utilize productivity, quality, and audit data to identify performance trends, coding gaps, and training opportunities
• Translate data insights into actionable feedback, performance improvement plans, and targeted education
• Assist with onboarding and training of new coding staff
• Support the Risk Adjustment Manager with day-to-day departmental operations, including workflow coordination, prioritization of audits, and issue resolution
• Assist in developing and maintaining standard operating procedures, workflows, and best practices
• Analyze Risk Adjustment data (e.g., recapture rates, audit findings, productivity, denial trends) to support departmental strategy and prioritization
• Collaborate with leadership to design and implement new or enhanced workflows for coders based on data, performance metrics, and operational needs
• Support reporting and dashboard development to track coding performance, quality outcomes, and Risk Adjustment impact
• Escalate operational, compliance, or performance issues to leadership as appropriate
• Review provider documentation and medical records to ensure all Medicare Advantage and Commercial Risk Adjustment requirements are met
• Perform and/or oversee retrospective and prospective medical record reviews to identify, assess, monitor, and document HCC coding opportunities
• Conduct coding quality audits to ensure ICD-10-CM codes are accurately assigned and supported by clinical documentation
• Analyze audit results to identify systemic coding or documentation trends and recommend process improvements
• Prepare audit analyses and provide feedback on noncompliance or documentation improvement opportunities
• Interact with physicians and provider office staff regarding coding, billing, and documentation policies and procedures
• Deliver education and training on Risk Adjustment and documentation improvement, both individually and in group settings
• Assist with the development of educational materials and presentations, including PowerPoint content

Supervisor – Risk Adjustment

Director

• Provide strategic direction for the claims department, aligning operations with company goals and regulatory requirements
• Lead, mentor, and develop a high-performing claims management team
• Collaborate with executive leadership to establish and achieve claims-related KPIs and financial targets
• Identify the root cause of any operational weaknesses and implement the best solution
• Serve as a thought partner to internal and external stakeholders to achieve mutual goals
• Oversee end-to-end claims operations, claims processing, adjudication, and resolution to ensure timeliness, accuracy, and compliance
• Develop, implement, review dashboards, reports, policies, procedures, and workflows to optimize efficiency and mitigate errors
• Team accountability for areas such as – timeliness reporting to the health plans, encounter reports, weekly inventory and workflow reports, and IPA claims summary report for board meetings
• Monitor and address claim denial trends, providing actionable insights and corrective strategies
• Manage relationships with payers, third-party administrators, and other key stakeholders
• Ensure compliance with state, federal, and industry regulations, including HIPAA and CMS guidelines
• Prepare and present regular reports on claims performance, trends, and department metrics
• Conduct audits and reviews to maintain high standards of accuracy and compliance

Director – Claims

Analyst

• Own workstreams within cross-functional strategic initiatives from planning through execution
• Develop structured analyses to inform leadership decisions (financial, operational, and performance data)
• Build executive-ready materials including presentations
• Partner with Operations, Finance, Analytics, Network, Contracting, Clinical, and Technology teams to drive alignment and execution
• Identify operational gaps and propose practical, scalable solutions
• Track initiative progress, manage risks, and escalate issues as needed
• Support development of repeatable processes and project management standards across initiatives