Michelle Tulier, Cpc-I, Cdeo, Cfpc, Cpb, Cpco, Cpma, Crc Email & Phone Number

Conduct training sessions that focus on Medicare Advantage, ACA, Medicaid risk adjustment, and HEDIS/Quality products. Collaborate with instructional designers and teams to identify training needs. With a strong background in the healthcare industry, particularly in risk adjustment, I utilize my communication and organizational skills to effectively engage.

California, United States

• Specialized in provider engagement and risk adjustment education across 18 states. My role involved creating and delivering educational content related to HCC Risk Adjustment, ICD-10-CM coding, and HEDIS documentation.
• Developed and facilitated training for providers and coders. Training was conducted in group and one-on-one settings regarding the risk adjustment methodology, documentation and coding improvement, and closing gaps.
• Created and delivered educational content and coding tools for use in Medicare Advantage (MA; CMS-HCC), Medicaid, and Affordable Care Act (ACA; HHS-HCC) risk adjustment and quality (HEDIS) programs.
• Collaborated with healthcare practices, IPAs, and medical groups to improve their participation in risk adjustment programs, analyzed data to identify performance opportunities, and implemented strategies for enhanced.
• Conducted targeted medical chart reviews and provided feedback to optimize documentation accuracy and coding improvement.
• Achieved an 87% pass rate for the Certified Risk Adjustment Coder (CRC) course, with over 90 internal staff members participating.

San Francisco Bay Area

• Focused on provider relations, strategic outreach, and education. Analyzed program performance with medical groups, IPAs, and provider practices to improve performance related to risk adjustment and HEDIS quality.
• Trained provider groups on ICD-10-CM coding and risk adjustment tools to capture gaps in coding and improve provider performance for primary care physicians and specialists.
• Served as a liaison between MA plans, medical groups, and providers related to risk adjustment and quality (HEDIS) programs.
• Developed coding tools and presentations for provider training.
• Conducted targeted chart reviews to identify opportunities for improvement and provided ongoing feedback and training.
• Consultative meetings with IPAs, medical groups' c-suite, and additional staff based on data, performance indicators, and CMS-HCC updates or changes.

Foster City, California, United States

• Developed and implemented a CMS-HCC risk adjustment program for a Management Service Organization (MSO) overseeing a medical group and IPA. I provided leadership in creating coding tools, presentations, and strategies.
• Designed and launched solutions to track HCC diagnosis codes, improving risk adjustment compliance. Co-created a software module for risk adjustment.
• Led educational initiatives, training providers, coders, and office staff on HCC risk adjustment and documentation best practices.
• Collaborated with medical groups to enhance provider engagement and relations, ensuring adherence to risk adjustment and regulatory guidelines.
• IT help desk for MSO’s software program.

Gilroy, California, United States

Managed all aspects of the medical billing process, including accounts receivable, payment tracking, and claim resolution. Assisted with front-office patient check-in, eligibility verification, and authorization submissions.

Bachelor Of Liberal Studies, Psychology

Summa Cum Laude

Substance Abuse/Addiction Counseling

Electives