Claims Delegation & External Audit Supervisor

Astrana Health, Inc.; Monterey Park (CA); Hybrid; USD 78,000 - 91,000; Full time

Job summary

Astrana Health, Inc. in Monterey Park, CA is seeking a Supervisor - Claims Delegation Oversight to lead external audits, manage audits with DMHC/CMS, and drive the overall audit program.

This role will develop and execute department strategies, optimize the audit process, and leverage data to minimize costs in claims. The incumbent will collaborate across departments to ensure regulatory and internal guideline compliance, manage CAPs, and improve audit outcomes while supporting a hybrid work

Qualifications

• Solid understanding of DHCS, CMS, DMHC rules and regulations governing claims adjudication practices.
• Detail knowledge of Medi-Cal, Medicare, and Medicaid program guidelines.
• Ability to analyze and process all levels of claims with CMS and DMHC regulations.
• Bachelor degree or equivalent education and experience required.

Responsibilities

• Plan, execute and support external audits to ensure readiness and improve audit scores.
• Lead end-to-end lifecycle of external audits (health plan, DMHC, CMS).
• Create and monitor metrics for audits; track and report results.
• Collaborate with reporting to ensure universe listings are accurate and timely.

Skills

Leadership

Analytical skills

Regulatory knowledge

Education

BS/BA or equivalent

Tools

Excel

Job description

Astrana Health, Inc. in Monterey Park, CA is seeking a Supervisor - Claims Delegation Oversight to lead external audits, manage audits with DMHC/CMS, and drive the overall audit program.

This role will develop and execute department strategies, optimize the audit process, and leverage data to minimize costs in claims. The incumbent will collaborate across departments to ensure regulatory and internal guideline compliance, manage CAPs, and improve audit outcomes while supporting a hybrid work