Astrana Health

Learning and Development

• Assist in the development, design, and delivery of engaging learning content (in-person and online).
• Maintain and update training materials, guides, and multimedia content.
• Support the monitoring and evaluation of training efforts to help improve effectiveness.
• After completing Astrana’s trainer certification, co-facilitate and later independently facilitate learning sessions online and in-person.
• Support onboarding, leadership development, compliance, skill building and operational training programs.
• Other duties as assigned.
• Serve as a secondary point of contact for Litmos-related questions, basic troubleshooting, and system support tasks.
• Manage user accounts, course enrollments, reporting, and assist with system configuration.
• Generate LMS analytics, track participation, and report on training outcomes.
• Collaborate with training leaders and other stakeholders to understand team learning needs and participate in recommending solutions.
• Support projects to enhance employee engagement, knowledge retention, and performance improvement.
• Assist with communications, reminders, and follow-ups related to learning initiatives.
• Identify opportunities to enhance learning programs and improve processes.
• Stay current on adult learning trends, LMS innovations, and instructional best practices.
• Participate in cross-functional projects and special initiatives as needed.
• Must have an entrepreneurial, growth mindset around AI (artificial intelligence).

Learning & Development Training Associate

Medical Billing and Coding

• Conduct high-volume chart reviews to identify coding gaps, trends, and opportunities for improved accuracy for our providers.
• Translate findings into actionable insights, creating and delivering education to providers and practice leaders while navigating complex conversations.
• Track and report on key performance metrics—such as HCC recapture rates, AWVs, and other KPIs, helping drive provider performance and overall program success.
• Interact 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.
• Provide recommendations related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
• Train and mentor new employees during the orientation process.

Risk Adjustment Coding Specialist II

• 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

• 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

• 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
• Other duties as assigned

Supervisor – Risk Adjustment

Financial Planning and Analysis

• Take the lead in monthly financial reporting preparation, management reports and key performance indicator (KPIs)
• Perform financial analysis, which includes ROI assessments, cost-benefit analysis, and variance analysis to enhance strategic decision-making
• Collaborate with department heads, serving as their partner in understanding and addressing their financial requirements
• Consistently dive into industry trends and best practices in strategic finance
• Partner with other cross-functional teams to develop, support, and improve the systems, policies, and procedures necessary to drive efficiency and provide meaningful financial data
• Analyze financial, operational, and accounting data to develop reports for various business segments and support decision-making
• Utilize financial information and claims data to build out reporting and analytics to guide business decisions and improve business unit performance
• Perform trend analyses to identify and implement opportunities to increase profitability for business leads

Analyst, Senior Analyst – Financial Operations

Manager

• 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/RN

• 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.

Analyst

• Oversee daily data operations, including data entry, processing, and reporting.
• Help optimize data workflows and processes to enhance efficiency and reduce errors.
• Monitor data systems and troubleshoot issues to ensure uninterrupted data flow.
• Liaison between internal/external stakeholders and data engineering team.
• Monitor daily file exchanges between systems, vendors, and partners.
• Oversee tracking of all health plan and vendor data files to ensure data quality, integrity, and timeliness.
• Collaborate with the Data Engineering team to build and optimize automation pipelines for data ingestion and validation.
• Maintain documentation for file transfer workflows, system configurations, and troubleshooting procedures.
• Ensure files are delivered successfully via SFTP, FTP, FTPS, or Managed File Transfer (MFT) tools.

File Exchange & Automation Analyst

Human Resources

• Provide day-to-day operational and administrative support to the Human Resources team including documentation preparation, data entry, employee records maintenance, and responding to routine HR inquiries.
• Support employee onboarding processes including new hire documentation, background checks, onboarding coordination, and I-9 verification.
• Maintain accurate and up to date employee records within the HRIS system and ensure employee files are maintained in compliance with company policies and regulatory requirements.
• Assist with employee offboarding processes including separation documentation, HRIS updates, and coordination with payroll, benefits, and other internal departments.
• Respond to employee inquiries related to HR policies, procedures, and employee programs, escalating more complex matters to appropriate HR leadership when necessary.
• Assist with preparation of HR reports, tracking logs, and documentation to support HR operations and compliance requirements.
• Support HR initiatives and projects as assigned.
• Provide day-to-day support to the Benefits Administrator in the administration of employee benefit programs including medical, dental, vision, life insurance, disability, and voluntary benefits.
• Assist with employee benefits enrollment processes including new hire enrollments, qualifying life event changes, eligibility updates, and benefit terminations.
• Respond to routine employee inquiries regarding benefits eligibility, enrollment procedures, plan options, and vendor contacts.
• Maintain benefits related records and assist with documentation to ensure accuracy and compliance with company policies and applicable regulations.
• Support open enrollment planning and administration, including employee communications, enrollment tracking, and documentation support.
• Coordinate with benefits vendors and internal teams to ensure timely and accurate processing of benefit enrollments and changes.

HR Operations – Benefits Coordinator

Compliance

• Research and interpret complex policies regarding government programs requirements and maintain tracking of all delegation oversight activities from contracted delegated health plans, entities and vendors.
• Coordinate strategic communications and audits with delegated entities and internal business departments.
• Manage assigned health plan audits. Independently execute special assignments with general supervision. Monitor oversight and assist in ensuring compliance to regulatory standards and health plan contracts. Apply critical thinking and problem-solving skills to all actions.
• Track and trend areas of compliance and regulatory vulnerability and risk within the organization and assist in developing solutions to enhance processes. Assist Compliance Leadership in developing and coordinating compliance training materials for the company.
• Coordinates the preparation and completion of compliance program materials, documents, presentations, and department activities with a focus on auditing and monitoring processes.
• Analyze and interpret health plan audits instructions, requests and results, and distribute to operational departments. Use critical judgment to work on developing improvement plans as it pertains to Medicare, Medicaid, Commercial, and Duals program corrective actions.
• Assist in tracking audit submissions and maintaining internal documentation for consistency. Work collaboratively with all departments to follow up on audit items and ensure accuracy of information provided and timely submission, as needed.
• Works on ad hoc projects, routine assignments, and recurring tasks under the direction of Compliance leadership. Assist Compliance Leadership in documenting and analyzing changes across departmental policies when modifications are required due to audit findings and/or regulatory changes. Communicate required changes with business leads and ensure timely compliance with changes.
• Assist with drafting new policies and updating existing policies as required to ensure regulatory compliance, identifying areas of risk and recommending improvements.
• Assist in the design and execution of internal audits to assess the effectiveness of compliance controls and operational processes.
• Helps to identify complex problems and review related information to evaluate options and implement solutions.
• Ensure data accuracy and integrity through periodic audits and continuous monitoring.
• Assists in compiling data, analyzing, and producing quarterly and monthly reports.
• Supports maintenance of peripheral databases that support Corporate Compliance reporting needs.
• Performs periodic audits to ensure the accuracy and integrity of the data.
• Manage time efficiently to meet expected deadlines and maintain productivity in compliance and audit activities.

Compliance Specialist – Regulatory Affairs

Compliance Specialist

• Review charges for completeness, compliance, and accuracy before claim submission.
• Validate CPT, HCPCS, ICD-10 codes, modifiers, place of service, and provider information.
• Confirm payer sequencing, insurance eligibility, demographics, and authorization requirements.
• Create and submit clean claims in eCW using approved workflows.
• Identify and correct missing or unsupported services prior to submission to prevent denials.
• Perform comprehensive follow-up on outstanding claims by payer and aging bucket.
• Investigate claim delays, denials, rejections, coding issues, and system errors.
• Contact payers via portals and phone to resolve claim issues and document outcomes.
• Submit corrected claims, appeals, and supporting documentation as needed.
• Identify denial trends and communicate recurring barriers to leadership.
• Support backlog clean-up initiatives and improvement in cash flow performance.
• Maintain clear, complete documentation on 100% of touched claims including date/time, action taken, outcome, representative/contact reference, and next steps.
• Follow eCW queue workflows and approved action/result codes.
• Ensure claims do not remain inactive beyond three (3) business days.
• Work closely with Coding, Credentialing, Payment Posting, Clinic Leadership, and RCM Management.
• Escalate barriers promptly (payer issues, missing documentation, portal problems).
• Assist with phone coverage and maintain excellent internal and external communication.
• Maintain professionalism, respect, and a solution-focused approach in all interactions.
• Maintain HIPAA compliance and protect PHI at all times.
• Follow Astrana SOPs, payer policies, and revenue cycle workflows.
• Uphold professionalism and courtesy in all interactions.

Learning & Development Training Associate

Risk Adjustment Coding Specialist II

Risk Adjustment Coding Specialist II

Risk Adjustment Coding Specialist II

Supervisor – Risk Adjustment

Analyst, Senior Analyst – Financial Operations

Case Manager, LVN/RN

Risk Adjustment Coding Specialist II

File Exchange & Automation Analyst

HR Operations – Benefits Coordinator

Compliance Specialist – Regulatory Affairs

Compliance Specialist

Medical Billing Specialist