Panorama

Medical Biller

• Prepare and submit claims to insurance companies for ophthalmology, optometry, retina, and ASC services
• Utilize CPT, ICD-10, and HCPCS codes to ensure accurate and compliant claims submission
• Review and resolve coding discrepancies or claim denials efficiently
• Track, review, and follow up on unpaid or denied claims
• Work with insurance carriers to resolve payment delays, appeals, and denials
• Ensure timely and accurate posting of payments and adjustments
• Communicate with patients to explain billing issues, resolve account discrepancies, and collect outstanding balances
• Collaborate with clinical and administrative teams to streamline billing workflows
• Stay updated on changes in coding guidelines, payer policies, and industry best practices

Pharmacist

• Submit and manage prior authorization requests for medications only, as required by insurance carriers.
• Review physician medication orders, supporting clinical notes, and documentation to ensure prior authorization requests are complete and accurate.
• Track medication prior authorizations from submission through approval, denial, or request for additional information.
• Follow up with payers to ensure timely determinations and minimize delays in medication access.
• Coordinate prescription refills in collaboration with providers and pharmacies.
• Serve as the primary point of contact for pharmacies regarding medication-related questions, clarifications, and insurance requirements.
• Support enrollment and coordination of patient assistance programs for medications when applicable.
• Communicate with patients regarding medication-specific authorization requirements, timelines, approvals, denials, and next steps.
• Identify medication prior authorization denials and coordinate appeals when appropriate.
• Manage assigned work queues, tasks, and follow-ups to meet defined turnaround times.
• Maintain compliance with payer requirements, HIPAA, and organizational policies.

Medical Biller

PSC, Medication Prior Authorization, Pharmacy