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 with internal and external stakeholders.

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 tailored to the needs of providers, coders, and medical staff.• 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 outcomes.• 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 measures. Trained internal and external staff on Optum’s risk adjustment and quality software program, InSite.• 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. • Collaborate on strategies for actionable solutions by sharing best practices, workflows, and areas of opportunity for process improvement.

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 to improve provider documentation and risk adjustment outcomes.• 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