Jobs at Astrana Health, Inc.

Review and abstract diagnostic documentation to ensure accurate ICD-10-CM and HCC coding for Medicare Advantage, ACA, and commercial risk adjustment. Perform retrospective and prospective audits, educate providers, meet productivity targets, mentor staff, report on project status, and recommend process improvements. Heavy travel to provider sites and use of EHR and coding software required.

Lead and monitor Claims Quality, Appeals and Recovery staff; audit claims and identify error trends; implement controls to minimize incorrect adjudication and overpayments; coordinate recoveries, provider education, system testing, and timely reporting; ensure compliance with legal, regulatory, and CMS requirements.

Manage provider lifecycle and network operations for the Los Angeles market, supporting onboarding, data accuracy, panel management, issue resolution, network adequacy, quality initiatives (HEDIS, STARS), regulatory compliance, cross-functional collaboration, reporting, and operational readiness to improve provider and member experience.

Manage end-to-end provider and vendor contracting: draft, negotiate, track, assemble, and file agreements; coordinate routing and signatures; update boilerplates for regulatory compliance; liaise with providers, vendors, and internal teams to resolve discrepancies; perform related administrative tasks and protect confidential information.

Lead and perform audits of health plan claims for DMHC/CMS compliance, document under/overpayments, analyze claims processes and error trends, coordinate corrective actions, collaborate across departments, and identify training needs.

Work on the CEO's small, cross-functional 'SWAT' team to translate high-stakes priorities into structured plans and drive execution across clinical, operations, and technology. Lead cross-functional alignment, identify process gaps, pilot and scale AI-enabled solutions, build dashboards and prototypes, and embed durable systems and frameworks to increase organizational performance.

Perform chart reviews and medical record abstraction to identify and close HEDIS care gaps. Apply NCQA HEDIS specifications and coding guidelines, validate and QA clinical data, support audits, collaborate with providers and vendors, analyze results for process improvement, and maintain HIPAA-compliant documentation while meeting productivity and accuracy targets.

Assist in the Operating Room by preparing and stocking rooms, maintaining sterile fields, positioning patients, supporting instrument sterilization and equipment checks, ensuring OR safety and proper specimen handling, and providing professional patient-centered communication.

Lead managed care contracting strategy and negotiations, draft and manage payer/provider contracts (risk-based, FFS, ACOs), evaluate reimbursement and financial performance, develop contract analytics/tools, ensure enterprise contracting consistency, resolve payer/provider issues, and manage ad-hoc projects.

Review and audit medical records to ensure ICD-10-CM and HCC codes support Medicare Advantage, ACA, and commercial risk adjustment. Abstract codes, perform quality audits, educate providers, meet productivity targets, prepare audit analyses, recommend process improvements, mentor staff, and lead projects as needed. Frequent onsite travel to provider sites (~75%).

Oversee daily claims processing, manage claims inventory, drive improvements for efficiency, resolve claims issues, and coach claims staff.

Embed with clinical and operations teams to identify high-impact problems and build production AI systems. Design and deploy LLM/RAG-driven tools, data pipelines, APIs, models, and user-facing applications using messy clinical and claims data. Iterate quickly based on real-world feedback and operational needs.

Lead design, development, deployment, and maintenance of scalable web applications and APIs for Astrana's healthcare platform. Collaborate cross-functionally, improve the stack and processes, mentor junior engineers, manage project priorities, and drive technical direction using Python, React, JavaScript, and SQL.

Perform medical record abstraction and chart review to identify and close HEDIS care gaps, ensure data accuracy and NCQA compliance, conduct QA reviews, collaborate with providers and audit vendors, analyze results, and support quality improvement and reporting.

Perform medical record abstraction and chart review to identify and close HEDIS care gaps. Apply NCQA HEDIS specifications, validate and submit clinical data, conduct QA reviews, collaborate with providers and vendors, support audits, analyze results for process improvement, and maintain HIPAA compliance while meeting productivity and accuracy standards.

Provide nursing case management for pediatric and adult patients: assess, plan, coordinate, monitor, and evaluate care transitions; review medical records for medical necessity using Milliman Care Guidelines; collaborate with hospitalists, discharge planners, health plans, and providers; perform onsite hospital case management and maintain utilization management compliance.

Plan, design, and deliver nursing education and orientation programs; assess and maintain clinical competencies; coach staff; support quality, safety, and professional development across nursing teams.

Prepare and reconcile financial statements and journal entries in accordance with U.S. GAAP, manage month/quarter/year-end close, coordinate audits and reporting to health plans, analyze revenues and expenses, maintain internal controls, and support ad-hoc financial tasks and regulatory submissions.

Responsible for building data models, developing ELT pipelines, implementing data quality checks, and utilizing best practices in data engineering and healthcare analytics.

Lead and mentor a team of data engineers to design, implement, and maintain scalable data pipelines, ensuring data quality and compliance with healthcare regulations.