| Richard Moore
Summary of Qualifications Independent consultant with over 30 years of experience with Healthcare Information Systems; Expertise in healthcare industry, project management, business analysis, business administration/operations, Electronic Data Interchange (EDI), Electronic Medical Record (EMR), Physician Practice Management (PM), State/Federal Integrated Eligibility System Design Projects, Health Information Exchange (HIE), Health Insurance Exchange (HIX), testing, training, support and consulting; Experience working directly with providers, payers, software manufacturers, electronic data interchange organizations, billing services, clearinghouses and government agencies; Excellent skills for communication, technical research and problem-solving. Efficient and effective leadership for cost effective solutions. Skill Areas back to top
Education and Training back to top
West Virginia Department of Health and Human Resources (DHHR), Charleston, WV West Virginia Integrated Eligibility System (WVIES), Requirements Subject Matter Expert (SME) with the WV State Project Management Office (PMO) 11/2018 9/2023 Requirements SME for the WV State PMO, participating in the large scale development of the WV Integrated Eligibility System named PATH (Peoples Access To Help) which will integrate all WV DHHR program eligibility, including Medicaid, Family Assistance, Social Services, Child Welfare and Child Support. Specific focus on the Child Welfare (CW) legacy system FACTS (Families and Children Tracking System) replacement with PATH. As a member of the Functional Requirements team, helping WV DHHR work with third party development vendors Optum, CGI and others. SME assisting CW by monitoring over 450 vendor design sessions, helping triage over 12,000 design issues, tracking 1,353 CW requirements in the 2,789 Requirement Traceability Matrix (RTM), help manage and perform validations of over 300 CW Deliverable Designs and doing special projects as assigned. Ohio Department of Medicaid (ODM), Columbus, OH - Ohio Medicaid Information Technology System (MITS), Project Manager, DXC (formerly HPE), Experis/NSI, DME Consulting Services - 3/2017 10/2018 Project manager for the Ohio MITS Medicaid Management Information System. Managed Projects from Large Scale (CMS Medicare Beneficiary ID change) to Small Scale (provider letter changes) as many as 9 projects simultaneously within multiple Project Domains - Eligibility, Business Operations, Financial, Claims and Managed Care. Project management technologies used - Microsoft Project, Hewlett Packard Project and Portfolio Management Center (PPMC), Hewlett Packard Compass Time Tracking (CATW). Interface projects from MITS to ODM Ancillary systems, Ohio Benefits (Ohio Integrated Eligibility System), Ohio Department of Jobs and Family Services (ODJFS) and external partners - Managed Care Plans (MCP), Automated Health Systems (AHS), Change Health and CMS. Philips Lifeline Government Services Department (GSD), Boston, MA - EDI Process Improvement EDI Specialists, DME Consulting Services - 7/2016 - 8/2016 - Business Analyst for EDI process improvement for Philips Lifeline GSD. In 2003 GSD made modification to their PeopleSoft Accounts Receivable system to produce the HIPAA Standard Claims Billing transaction, ANSI X12N 837 and receive the Standard Payment Remittance transaction, ANSI X12N 835. They implemented EDI solutions to translate and validate the transactions, then send or receive transactions to/from their Medicaid trading partners. but now in 2016 due to the growth in GSD business from 15 to 48 states, the increase in trading partners to 179 and the transaction volume growth to 800,000 EDI transactions per month, the EDI process is too manual and slow for current business requirements. GSD overall goal was to strategically reduce their manual processes and incorporate as much process automation as possible. Analysis involved meeting with Stakeholders and Project leadership, meeting with Subject Matter Experts (SME), observation of real-time operational processes, gathering GSD technical history and current Philips corporate technology, defining GSD pain points in the claims, eligibility and clearinghouse processes, analyze EDI processes for translation, validation, communications and electronic funds transfer (EFT), create GSD requirements and specifications for vendor responses, engage vendors to solicit bids and guide through discovery, and make recommendations for EDI process improvement to GSD management. Indiana Eligibility Determination and Services System (IEDSS) Project, Family and Social Services Administration (FSSA), Division of Family Resources (DFR), Indianapolis, IN - First Data Indiana IV&V, Diversant LLC, DME Consulting Services - 12/2015 - 5/2016 - Technical Analyst - Analyzing the preparedness of FSSA/DFR (DFR aka Indiana Medicaid) and Indiana Office of Technology (IOT) in meeting the requirements of the Federal Government to obtain an Authority to Connect (ATC) for the new Indiana Medicaid Indiana Eligibility Determination Services System (IEDSS). Areas of review and recommendation included: Interviewing External vendor RCR Document Management System; CMS System Security Plan (SSP); Minimum Acceptable Risk Standards for Exchanges (MARS-E) versions 1.0 & 2.0; Plan of Action and Milestones (POA&M) Report for SSP from MARS-E v 1.0; Memorandum of Understanding between DFR and IOT; Deloitte IEDSS Deliverable documentation especially the Technical Architecture, Updated Operations Documentation/Processes, Operational Readiness Plan, Business Impact Analysis, Contingency Planning/Continuation of Operations, Schedule of Work for Stage 2; IRS Security Guidelines Publication 1075; Safeguards for Social Security Administration (SSA) provided electronic information; Security Guidelines for Food and Nutrition Services (FNS) electronic information. Gather standards-based recommendations for operations including: Information Technology Infrastructure Library (ITIL)/IT service management (ITSM); Microsoft System Center; Configuration Management Database (CMDB) solutions; Service Level Agreement/Key Performance Indicator evaluation. Centers for Medicare & Medicaid (CMS) Center for Consumer Information and Insurance Oversight (CCIIO) Enrollment Resolution and Reconciliation (ER&R), 100% Remote, Cognosante, EDI Specialists, DME Consulting Services - 2/2015 7/2015 - EDI Analyst to troubleshoot issues with tax form 1095-A - the Health Insurance Marketplace Statement generated for the 2014 Tax reporting period related to enrollment in the Healthcare.gov Federally Facilitated Marketplace. Document the issues and provide resolution. Assigned to VIP and Correlated Cases teams working the most difficult and high visibility issues. Permissions granted to work on CMS Health Insurance Casework System (HICS), Remedy and Access via CMS Enterprise User Administration (EUA). Knowledge and analysis of data held in the CMS Multidimensional Insurance Data Analytics System (MIDAS), Enrollment Database Online (CMS Medicare beneficiary entitlement record aka EDBO) and x12 834 pre-audit files. Ohio Department of Medicaid (ODM), Columbus, OH - Medicaid Information Technology Architecture (MITA) State Self-Assessment (SS-A), Senior Consultant, CSG Government Solutions - 2/2014 to 8/2014 - Local resource for the ODM MITA SS-A Framework 3.0, working with both Business and Technical teams. Helped with 80 Business Process Workshops to document the ODM As-Is and To-Be maturity levels. Produced the full set of Business Process Model and Notation (BPMN) models for the ODM business processes in Microsoft Visio documents. Helped with 10 Technical assessment workshops to document the As-Is and To-Be maturity levels for the Business Architecture, Information Architecture and Technical Architecture including the Seven Conditions and Standards. Helped with the analysis of the ODM Ancillary systems, the ODM Medicaid Information Technology System (MITS), the Ohio Benefits and Ohio Integrated Eligibility System (OIES), Business Intelligence System (BI or Ohio Data Warehouse) and selected external systems with the Ohio Department of Jobs and Family Services (ODJFS). including a review of interfaces. Health Insurance Exchange (HIX) - 1/2013 to 4/2013 - Architect - Blue Shield of California Electronic Data Interchange (EDI) implementation requirements necessary for their participation as a Qualified Health Plan (QHP) in California's HIX - Covered California. Evaluation and recommendations for Enrollment management involving Edifecs XEngine, IBM Websphere Enterprise Service Bus, SQL Databases, Trizetto Facets Middleware, Trizetto HIPAA Gateway, ETL, J2EE coding, enhancements for reconciliation and reporting. Ongoing work and training as member of CMS Registration and Technical Assistance Portal (REGTAP) with primary focus on enrollment, financial transactions and EDI. Participant in the WEDI HIX workgroup. Healthcare IT Consulting Services - 2008 to Present - Work to implement electronic healthcare technology for physicians; Electronic Health Records, Health Information Exchange and Mobile Office Resources. Supplying project management, vendor management and multi-vendor coordination for primary care providers implementing clinical and administrative systems solutions supplied by multiple healthcare vendors. Medicaid Management Information System (MMIS), CNSI - 2006 to 2008 - Business Application Consultant for HIPAA Transactions 820 and 834 for a web-based Washington and Michigan State MMIS projects and general HIPAA transaction consulting. Edifecs SpecBuilder and XEngine transaction testing, Gentran translator configuration, data modeling, metadata analysis, transaction use cases, Java programming review, ClearCase/ClearQuest, VisualBasic, and Visual SourceSafe; HIPAA Consulting, SummaCare, Inc. - 2003 to 2009 - HIPAA transaction implementation, operational conversion and management consulting. Creation of HIPAA Implementation Companion Guides. HIPAA transaction testing and Edifecs testing tool training. eHealth Ohio, Inc. - 2003 to present - President 2006 to Present. Strategic leadership, Healthcare technology advocacy, outreach on best practices to the healthcare stakeholders of Ohio; Administrator of eHealth Ohio HIPAA Transaction Testing Portal using Edifecs RAMP technology 2003 to 2008. Perform oversight on testing and answer testing questions from community members. Testing includes NCPDP, HL7, HIPAA X12 4010A1. ICD10 and 5010A1 Healthcare Transactions. Project lead for HIMSS - GSA - Kantara Initiative e-Authentication project modeling Open Source Health Information Exchange and Healthcare Identity Management. Ohio Health Information Network, HTP, Inc. - 2005 to 2006 - Central Ohio lead consultant to develop a prototype for a Nationwide Health Information Network (NHIN) Architecture and NHIN Proposal development for the Utah Health Information Network (UHIN). Central Ohio Project Team included HTP, The Ohio State University Medical Center (OSUMC), OhioHealth System, Ohio Department of Health (ODH), OSU Comprehensive Cancer Center, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC), Ireland Comprehensive Cancer Center of University Hospitals of Cleveland, Case Western Reserve University Medical School, Ohio State University Physicians Group (OSUPG), Medical Group of Ohio (MGO), Ohio Supercomputer Center (OSC), Third Frontier Network and Board of Regents, Ohio Hospital Association (OHA) and Mount Carmel Health System. CMHC Systems, Inc. Behavioral Healthcare Software - 2004 to 2005 - Professional Services Organization consultant for Project Management, Business Assessment Services and Implementation Services for Behavioral Health Client in California. Consulting on HIPAA ASC X12 transactions 837, 835 and Ohio MACSIS EDI transactions and reporting; MACSIS & HIPAA Compliance Training and Consulting - 2000 to present - Training Providers and Payers on Electronic Transaction and Code Set requirements and implementation of ASC X12 HIPAA Transactions. Consulting on HIPAA Privacy and Security. HIPAA Transaction consulting and testing support for Behavioral Health providers claims submissions to Ohio Medicaid MACSIS EDI system for payment. Consulting on ODMH/ODADAS data warehouse reporting and MACSIS data warehouse reporting on electronic Billing/Remittance, Behavioral Health Statistics, Mental Health Outcomes and custom reporting. Coordination of third party payers. General MACSIS consulting - 81 ADAMHS agencies and boards in 42 counties, implementing Behavioral Health Information Management Systems, providing training, conversion, electronic data exchange, reporting and project management; Ohio Corporation for Health Information (OCHI) - 1998 to 1999 - Community Health Information Network (CHIN) Public/Private Pilot project. Project management for the development of software and infrastructure for X12 EDI claims submission from Ohio employers and providers to Ohio Managed Care Organizations (MCO) and the Ohio State Bureau of Workers' Compensation (BWC). Key partners Ohio State Department of Health, the Ohio State University Medical Center, Anthem BC/BS, Cerner/Health Network Ventures, and the Ohio Manufacturers Association; Anthem Blue Cross/Blue Shield, Anthem Inc., Managed Care Systems & Digital Insurance Systems Corporation, Inc. - 1991 to 1998 - Business Analyst, Implementation Specialist, Functional Architect, Team Leader Support Services, Support Services Representative and Independent consultant. Extensive work with Payer systems - Claim processing, Enrollment and Administrative/Financial systems. Insurance Managed Care Software development including implementation, conversion, training and project management. Architect for HIPAA development. EDI file exchange and data warehouse query, reporting and data repair of billing and claims data. Community Mutual Blue Cross/Blue Shield, Community Mutual Insurance Company - Business Information Systems, Hospital Coordinator - 1988 to 1989 - Hospital electronic claims service for Ohio hospitals. Sales and Marketing of Electronic Claims Software, Communication Devices and Hardware to hospitals. Coordination of support services. Biographical Information: back to top Richard Moore is the owner and president of DME Consulting Services. He has over 30 years experience with Healthcare Information Systems working with public and private organizations. His broad-based knowledge of health information systems and operations comes from experience working directly with providers, payers, software manufacturers, electronic data interchange organizations, billing services, clearinghouses and government agencies. He is the current president of eHealth Ohio, Inc., a non-profit regional affiliate of the national standards development organization Workgroup for Electronic Data Interchange (WEDI). His primary WEDI focus is HIPAA X12 EDI transactions and he has participated as an author on WEDI testing whitepapers. He recieved the WEDI Award of Merit in October 2012 for his efforts for eHealth Ohio. He is an active participant in the Healthcare Information and Management Systems Society (HIMSS) and is a past National Chair of the HIMSS Chapter RHIO Liaison Roundtable. He is a member of the Board of the Central and Southern Ohio HIMSS (CSOHIMSS) Chapter and is the Chapter Past-President. He is the past RHIO Liaison for the State of Ohio, the past Advocacy Chairman and in 2008 started the Ohio HIMSS Advocacy Day now called Ohio Healthcare Information Technology (OHIT) Day. He is the recipient of the 2016 HIMSS Chapter Advocate of the Year. He was involved in the Healthcare Information Technology Standards Panel (HITSP) on the Security, Privacy and Infrastructure technical committee (SPI-TC) and the EHRLite Tiger Team (specifications for Meaningful Use). Also he is a founding member of the Liberty Alliance Health Identity Management Special Interest Group (HIM-SIG) which became the Kantara Initiative Healthcare Identity Assurance Workgroup (HIAWG). He has been a project leader for a HIMSS/GSA initiated study on the use of the GSA e-Authentication model for the Nationwide Health Information Network (NwHIN) focusing on electronic identity management, secure electronic health information exchange and federated single sign-on. Recent Presentations and Publications back to top "Patient Identity", October 12, 2012, CSOHIMSS Fall Conference 2012, Columbus State Community College, Columbus, Ohio, https://www.slideshare.net/RkMoore1/room-407-rick-moore-patient-identitypptx HIMSS HIELights, Kantara HIAWG PIDS Project Studies Patient Identity, Authentication, and Authorization. October 2011, HIMSS 2010 Annual Conference, Atlanta, GA, March 2010, "Healthcare Identity Management and Role-Based Access in a Federated NHIN - The e-Authentication Project Phase 4", http://www.slideshare.net/rkmoore/healthcare-identity-management-and-rolebased-access-in-a-federated-nhin-the-eauthentication-project-phase-4 HIMSS 2009 Annual Conference, Chicago, IL, April 2009, "Health Identity Management and Role-Based Access Control in a Federated NHIN Model - The e-Authentication Project Phase 3", http://www.slideshare.net/rkmoore/170-moore-fraser-e-authentication HIMSS 2009 Annual Conference, Chicago, IL, April 2009, "HIMSS State Advocacy Day Roundtable", http://www.slideshare.net/rkmoore/307-moore-final-20090407 TEPR 2009, Palm Springs, CA, January 2009, "Health Identity Management and Role-Based Access Control in a Federated NHIN Model - The e-Authentication Project Phase 3" National HIT Week 2008, Washington, D.C., June 2008, "Roundtable Discussion on HIMSS State Advocacy Day" HIMSS Chapter Advocacy Leader Representative training. HIE: Health ID Exchange? Ohio is a test bed for how identity management might fare in a world of networked health care, Government Health IT, June 2008 HIMSS 2008 Annual Conference, Orlando, FL, February 2008, "Joining the Club: e-Authentication and Authorization in an NHIN World." HIMSS/GSA National e-Authentication Project Whitepaper, Copyright June 2007, Healthcare Information and Management Systems Society, Participating Author. http://www.slideshare.net/slideshow/embed_code/27820829 CSOHIMSS, 2006 Fall Conference, Columbus, OH, "HIMSS/GSA E-Authentication Initiative - A Pilot Project of the HIMSS RHIO Federation." Ohio Health Information Technology (OHHIT) Annual Meeting, Fall 2005, Columbus, Ohio, "OHIN - Community for Health Information Exchange." WEDI Scenario Testing White Paper, December 2005, Workgroup for Electronic Data Interchange, Participating Author. EMR Roadshow, July & August 2005, Columbus & Cincinnati, Ohio, "You Have an EMR, What's Next?" EMR Roadshow, July & August 2005, Columbus, Ohio, "EHR Introduction for the Practicing Physician"
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