The Role
Owns tracking, modeling, forecasting, and executive reporting for health plan incentive revenue across Medicare Advantage, Medicaid, Commercial, Exchange, and ACO programs. Monitors quality measures and payout thresholds, identifies revenue opportunities and risks, reconciles internal and plan-reported results, and supports contract negotiations. The role also builds repeatable data pipelines, quality controls, dashboards, and recommendations while partnering with clinical, operational, data engineering, and executive stakeholders.
Summary Generated by Built In
About the Role
As Senior Analyst/Manager, Incentive Programs at Astrana Health, you will own the tracking, quantification, and reporting of performance and earned revenue across the health plan incentive programs in which Astrana participates, spanning Medicare Advantage, Medicaid, Commercial, Exchange, and ACO populations.
As Senior Analyst/Manager, Incentive Programs at Astrana Health, you will own the tracking, quantification, and reporting of performance and earned revenue across the health plan incentive programs in which Astrana participates, spanning Medicare Advantage, Medicaid, Commercial, Exchange, and ACO populations.
These programs are a material and growing share of Astrana's earned revenue, but terms, measure sets, payout curves, and data requirements differ by plan, line of business, and market. This role brings one quantified view to that landscape: what dollars are available, what we are on pace to earn, what we are at risk of leaving on the table, and where an incremental unit of operational effort produces the greatest return.
What You'll Do
Incentive Program Inventory & Revenue Opportunity Modeling
- Maintain a current inventory of health plan incentive programs across all lines of business, including measure sets, payout structures, attainment thresholds, gates, data requirements, and payment timelines
- Translate contract and program terms into a quantified revenue opportunity model at the plan, market, IPA, and measure level, and maintain a running view of dollars available, earned to date, and still achievable
- Quantify the marginal value of each incremental gap closed so effort and spend can be directed toward the highest yield measures
Performance Monitoring & Measure Prioritization
- Monitor performance against payout thresholds throughout the year, with attention to measures sitting near a tier boundary in either direction
- Identify high value measures using dollar weight, distance to threshold, denominator size, remaining runway, and feasibility, and set internal targets tied to payout tiers rather than generic benchmarks
- Provide early warning when projected performance will miss a threshold, while there is still time to intervene
Executive Reporting, Forecasting & Risk Identification
- Produce monthly executive reporting covering year to date performance and revenue earned, projected year end performance and revenue, and change versus prior month and prior year with drivers
- Build dashboards and recurring reporting that are legible without an analyst present, and present findings, risks, and recommendations to senior leadership and in board, health plan, and market reviews
- Maintain a consistent, documented, auditable projection methodology so month over month movement reflects real performance change rather than methodology drift
- Surface the largest revenue opportunities and downside risks with quantified impact, a recommended owner, and a recommended action, and track them to resolution
- Reconcile Astrana's internal performance view against health plan reported results, investigate variances, and identify systemic causes including missing supplemental data, encounter submission gaps, attribution errors, and measure logic misalignment
Cross-Functional Strategy & Data Management
- Partner with the Chief Quality Officer and the President of Physician Enterprise to inform strategy and resource allocation across Quality, Utilization and Care Management, Encounter Submission, and Member Experience
- Support health plan contract negotiation with analysis of historical performance, achievability of proposed thresholds, and expected value under alternative terms
- Ingest, normalize, and reconcile data from plan reports, portal extracts, flat files, claims and encounter data, EMR feeds, and vendor files into repeatable, documented pipelines
- Establish data quality checks and reconciliation controls, document known data limitations, and partner with data engineering on durable reporting infrastructure as the function scales
Qualifications
- Bachelor’s degree in a quantitative, public health, health policy, business, or related field, or equivalent practical experience
- 3+ years (Senior Analyst) or 5+ years (Manager) of analytic experience in a health plan, IPA, MSO, or provider organization
- Working knowledge of HEDIS and Medicare Stars measure specifications, including administrative, supplemental, and hybrid data sources
- Familiarity with value-based care economics: pay-for-performance, shared savings, withholds, and capitated risk
- Strong SQL and advanced Excel, working independently against large and imperfect datasets
- Demonstrated experience building recurring executive reporting and translating analysis into a defensible recommendation
- Comfort with ambiguity in source data, the judgment to know when a number is good enough to act on, and the discipline to state the confidence level
- Excellent written and verbal communication with senior executives, and the accountability to manage multiple concurrent reporting cycles
Preferred Qualifications
- Direct experience with Medicare Advantage Star Ratings, Medicaid quality withhold or incentive programs, or ACO REACH and MSSP quality reporting
- Experience reconciling internal performance calculations against health plan reported results, and reading and operationalizing health plan incentive contract language
- Proficiency with BI tools (Power BI, Tableau, Looker) and with Python or R
Environmental Job Requirements and Working Conditions
- This position is remotely based in the U.S. The home office is located at 1668 S. Garfield Ave. 2nd Floor, Alhambra, CA 91801.
- This role is required to attend occasional in-person meetings with internal departments or health plan partners.
- The national target pay range for this role is between $90,000 - $130,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
About
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient. Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.
Skills Required
- Bachelor's degree in quantitative studies, public health, health policy, business, or a related field, or equivalent practical experience
- 3+ years of analytical experience for Senior Analyst level or 5+ years for Manager level in a health plan, IPA, MSO, or provider organization
- Working knowledge of HEDIS and Medicare Stars measure specifications, including administrative, supplemental, and hybrid data sources
- Familiarity with value-based care economics, including pay-for-performance, shared savings, withholds, and capitated risk
- Strong SQL skills and advanced Microsoft Excel proficiency
- Experience building recurring executive reporting and translating analysis into defensible recommendations
- Ability to work independently with ambiguous, large, and imperfect datasets and communicate confidence levels
- Excellent written and verbal communication with senior executives
- Ability to manage multiple concurrent reporting cycles
- Direct experience with Medicare Advantage Star Ratings, Medicaid quality withhold or incentive programs, or ACO REACH and MSSP quality reporting
- Experience reconciling internal performance calculations against health plan reported results
- Experience interpreting and operationalizing health plan incentive contract language
- Proficiency with Power BI, Tableau, or Looker
- Proficiency with Python or R
Am I A Good Fit?
Get Personalized Job Insights.
Our AI-powered fit analysis compares your resume with a job listing so you know if your skills & experience align.
Success! Refresh the page to see how your skills align with this role.
The Company
What We Do
Astrana Health is a physician-centric, technology-powered healthcare company that operates an integrated delivery platform. It enables providers to participate in value-based care arrangements, helping them deliver accessible, high-quality, and cost-effective care to patients. The company provides care coordination services to patients, primary care physicians, specialists, and health plans, leveraging proprietary technology to streamline operations and improve patient outcomes across local communities.
