• Research, write, and revise high-quality, original editorial content • Ensure scientific accuracy while editing and referencing • Liaise with clients, authors and colleagues to progress projects effectively • Attend congresses, symposia and advisory board meetings as required and liaising with speakers and clients • Provide input on project specifications, costings and schedules, working with the internal account team to ensure projects are delivered to time and budget • Provide good briefings to colleagues and freelancers • Actively participate in account development meetings to grow repeat business • Mentor new writers

• The Senior Medical Writer is responsible for the development of medical writing deliverables that support the clinical regulatory writing portfolio • Preparing/Updating/Merging RMPs/Company Core-RMPs (CC-RMPs) • Managing scheduled and unscheduled aggregate reports including but not limited to Periodic Safety Update Reports (PSURs) • Conducting critical appraisal and systematic review of literature with a focus on background epidemiology • Performing aggregate report compliance activities including quality review • Coordinates and liaises with the members of Study Management Team (SMT) • Prepares clear and accurate narratives based on Clinical Database and Safety Database outputs provided by the client • Responsible for the end-to-end signal management process

Role Description Leads and supervises team responsible for payment integrity activities including recovery operations. Responsible for performance, quality levels and establishing procedures and techniques that achieve optimal payment integrity operational standards and production targets. - Supports implementation and execution of initiatives that include one or all of the following payment integrity activities: - Overpayment recovery - Pre and post-pay coordination of benefits (COB) - Subrogation - Premium enhancement managed service provider (MSP) - Data mining - Pre-pay editing for correct coding and medical payment policies - Supplemental oversight and vendor inventory management processing activities - Hires, trains, develops, mentors, and manages team responsible for executing projects and activities involving: - Inventory management and prioritization - Information reporting - Data management - Quality control procedures and workflows - Timely turnaround - Leads recovery processing, offset reconciliation, refund posting and reconciliation, provider dispute resolution, claim referrals and health plan special projects. - Ensures team meets or exceeds production targets. - Executes payment integrity programs that prioritize, identify and resolve payment/recovery issues. - Establishes procedures and techniques to achieve payment integrity operational standards. - Executes and monitors recovery inventory to ensure maintenance of performance and quality levels in payment integrity business products and processes. - Demonstrates expertise in claims processing, claims payment issue resolution, payment/adjustment error troubleshooting, and quality controls recovery adjustments. - Professionally communicates and responds to health plan/provider inquiries and understands when to escalate issues for resolution as appropriate. - Manages inventory production queues, and assigns and prioritizes work. - Analyzes complex data driven reports and develops actionable insights for resolution and leadership reporting. - Collaborates with payment integrity leadership to resolve recovery issues in collaboration with health plan operations. - Executes tasks and projects to ensure Centers for Medicare and Medicaid Services (CMS) and state regulatory requirements are met for: - Pre-pay edits - Overpayment recovery - COB and subrogation Qualifications - At least 5 years of experience supporting health care operations, including 3 years payment integrity/claims experience, or equivalent combination of relevant education and experience. - Ability to establish and maintain positive and effective work relationships with coworkers, members, providers and customers. - Strong organizational and time-management skills, and ability to manage simultaneous projects and tasks to meet internal deadlines. - Effective verbal and written communication skills. - Microsoft Office suite and applicable software program(s) proficiency. Preferred Qualifications - Management/leadership experience. - Managed care payor experience, preferably with Medicare/Medicaid. - Understanding of ICD-9/10CM, MS-, AP- and APR-DRG reimbursement. - Electronic medical record (EMR) and medical record repository experience. Benefits - Molina Healthcare offers a competitive benefits and compensation package. - Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

• Provides clinically based, concurrent and retrospective reviews of inpatient medical records. • Ensures documentation accurately reflects quality of care, severity of illness and risk of mortality to support compliant coding, reimbursement, quality reporting, and denials prevention initiatives. • Proactively contacts physicians or other clinicians as needed to clarify procedures/diagnoses to ensure proper documentation. • Performs initial case reviews and follow up reviews. • Submits compliant provider queries as needed to clarify documentation of relevant diagnoses, procedures, clinical indicators, present-on-admission status, acuity, specificity, and treatment in accordance with ACDIS/AHIMA compliant query guidance and organizational policy. • Applies knowledge of ICD-10-CM/PCS Official Guidelines for Coding and Reporting, AHA Coding Clinic, MS-DRG/APR-DRG methodology, CC/MCC capture, SOI/ROM, and quality indicators to support an accurate working DRG in collaboration with Coding/HIM. • Promotes a partnership with Coding/HIM team to ensure the accuracy of principal diagnosis, procedures, and completeness of documentation to determine the working and final DRG, severity of illness and risk of mortality. • Functions as a liaison between clinical and coding teams. • Actively engages and participates in delivery of education to providers through extensive interaction one on one. • Utilizes critical thinking skills and clinical reasoning to identify, clarify, and query accurate representation of documentation to reflect appropriate clinical status of the patient which will translate into quality reporting, physician report cards, reimbursement, public health data, and disease tracking and trending.