Senior Analyst/Manager, Incentive Programs

Department: Quality - Risk Adjustment

Employment Type: Full Time

Location: 1668 S. Garfield Ave. 2nd Floor, Alhambra, CA 91801

Reporting To: Jeremy Jackson

Compensation: $90,000 - $130,000 / year

Description

What You'll Do

• 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

• 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

• 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

• 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

• 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.