Medicare Provider Advocate in Fresno, California at LSMA Management Inc

JOB SUMMARY:

The Medicare Provider Advocate supports the implementation, execution, and optimization of Risk Adjustment strategies across the LaSalle provider network. This role collaborates with internal teams, health plan partners, and provider offices to ensure accurate, timely, and compliant capture of risk adjustment data.

The position serves as a key resource for education, performance monitoring, and operational support related to Medicare Risk Adjustment initiatives, with regular field engagement and cross-functional coordination.

MINIMUM & PREFERRED QUALIFICATIONS:

Education/Training

Minimum: High School Diploma or equivalent.

Preferred: Associate’s or Bachelor’s degree in healthcare, business, or related field

Experience

Minimum: Two (2) years of experience in healthcare or health plan experience.

Preferred: Experience in Risk Adjustment, healthcare analytics, or managed care. Experience working with provider groups and/or Medicare populations.

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

· Knowledge of Risk Adjustment principles, coding guidelines, and regulatory requirements

· Understanding of Medicare data collection, encounter data, and reporting processes

· Strong analytical and problem-solving skills with the ability to manage complex issues

· Excellent organizational skills with the ability to prioritize and manage multiple tasks

· Proficiency in Microsoft Office and general computer applications

· Strong written and verbal communication skills

· Ability to build effective working relationships with internal and external stakeholders

· Ability to work independently with minimal supervision

· Valid driver’s license and ability to travel using personal vehicle

PHYSICAL, MENTAL & ENVIRONMENTAL REQUIREMENTS:

The physical, mental, and environmental demands described here are representative of those required to successfully perform the essential functions of this job. The role requires frequent travel to provider offices and operational sites, along with the ability to sit, stand, and walk for extended periods. The position involves regular use of standard office equipment and computer systems, as well as the ability to manage multiple priorities in a fast-paced environment. The individual must be able to work standard business hours (8:00 AM – 5:00 PM) with flexibility as needed.

PAY RANGE

$36.05 - $38.46 / hourly