Medicare Provider Advocate at LSMA Management Inc

Fresno, California, United States -

Full Time

Start Date

Immediate

Expiry Date

15 Sep, 26

Salary

38.46

Posted On

17 Jun, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Risk Adjustment, HCC Coding, Medicare Advantage, Provider Relations, Analytical Skills, Problem Solving, Verbal Communication, Written Communication, Time Management, Microsoft Office, Medical Terminology, Claims Processes

Industry

Health and Human Services

Description

Description JOB SUMMARY: The Medicare Provider Advocate supports the implementation and execution of Risk Adjustment strategies across the provider network for Medicare lines of business. This role partners with providers, clinics, internal departments, and health plan partners to ensure accurate, timely, and compliant capture of risk-adjusted data. The incumbent serves as a subject matter resource for Risk Adjustment processes, providing education, operational support, reporting, and performance monitoring. This field-based role requires frequent travel within California and active engagement with provider offices to drive performance and regulatory compliance. Requirements MINIMUM & PREFERRED QUALIFICATIONS: Education/Training Minimum: High School Diploma or equivalent. Preferred: Associate’s or Bachelor’s degree in Healthcare Administration, Public Health, Business, or related field. Experience Minimum: Two (2) years of experience in healthcare, managed care, provider relations, or related field. Preferred: Experience in Risk Adjustment, HCC coding, or Medicare Advantage. Experience working with provider offices or healthcare networks. Any combination of educational and work experience that would be equivalent to the stated minimum requirements would qualify for consideration of this position. Certification(s) Certification in Coding, Billing, or Risk Adjustment Coding (e.g., CPC, CRC, CCS or equivalent) required. Skills, Knowledge & Abilities Working knowledge of Risk Adjustment, HCC coding, and Medicare Advantage requirements. Understanding of encounter data, supplemental data submissions, and regulatory compliance standards. Strong analytical and problem-solving skills with attention to detail. Effective verbal and written communication skills; ability to present information clearly to diverse audiences. Strong organizational and time management skills with the ability to manage multiple priorities. Ability to work independently and collaboratively in a team environment. Proficiency in Microsoft Office (Excel, Word, PowerPoint, Outlook) and ability to learn new systems quickly. Ability to build and maintain effective professional relationships. Knowledge of medical terminology, coding practices, and claims processes (preferred). PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS: The following requirements are representative of those necessary to perform the essential functions of this position, with or without reasonable accommodation. This role requires the ability to sit, stand, walk, and drive for extended periods of time, as well as frequent use of a computer, telephone, and standard office equipment. The incumbent must be able to occasionally lift and carry items weighing up to 15 pounds. The position involves frequent local travel, which may account for approximately 50% or more of work time, and requires the use of a personal vehicle, a valid driver’s license, and proof of insurance. The work environment includes a combination of office, remote, and provider site settings, and may require flexibility in scheduling to support operational needs. The role also requires the ability to analyze data, solve problems, adapt to changing priorities, and maintain professionalism and sound judgment while working under pressure. PAY RANGE $36.05 - $38.46 / hourly

Responsibilities

The Medicare Provider Advocate implements Risk Adjustment strategies and partners with providers to ensure accurate and compliant data capture. This role provides education, operational support, and performance monitoring through frequent field-based engagement.