Claims processor Jobs in Durham, NC

Job Summary

*This role will be based out of our various retail locations throughout North Carolina along with one day per week working from home supporting centralized services.*

Responsible for ensuring the proper compounding, dispensation, review, and verification of prescribed medications within regulatory guidelines, company policies and procedures. Works effectively in a hybrid work environment (such as Pharmacy store, Call Center, Micro-Fulfillment, and/or remote) and provides pharmacy consulting services with empathy to patients regarding the effective usage of medications and awareness of drug interactions leveraging omni-channel services (e.g., in person consultation and via the phone). Offers preventive and clinical healthcare services, including immunizations, diagnostic testing, and patient outcomes services. Supports the efficient workflow of the pharmacy and assists the pharmacy management in identifying ways to optimize pharmacy financials, inventory management and enhance the patient experience.

Job Responsibilities

• Performs pharmacist tasks, including compounding, drug therapy reviews, verification, and medication management. Reviews, interprets and dispenses prescribed medications.
• Enhances patient experience by focusing on healthcare services (e.g., patient consultation, medication management, drug therapy reviews) and retail, clinical, or wellness services such as immunizations, disease state management and specialty programs. Listens to patients concerns and issues, acts as a sounding board for pharmacy concerns and provides feedback to operations leaders. Resolves customer queries and issues in a timely manner to ensure a positive customer experience.
• Conducts centralized support, including patient registration, exception resolution, and assists with resolving patient issues. Performs in-person or virtual product/prescription reviews, within guidelines.
• Provides expertise, resources, education and support to broader team. Supports staff training and development opportunities. Promotes teamwork and motivates staff by fostering a shared vision;
• Supports company policies, procedures, mission, values, and standards of ethics and integrity.
• Partners with leadership team in analyzing performance (KPIs), financial and customer service data; Implements procedures for pharmacy asset protection and inventory management.
• Ensures the pharmacy adheres to regulations, company policies and standards. Collaborates with leaders to establish workflow procedures (e.g., assigning roles, coordinating activities and soliciting employee suggestions). Oversees pharmacy opening, closing and shift change.
• Maintains and develops relationships with medical providers and other health professionals.
• Ensures pharmacy staff follows up with medical providers’ to clarify prescriptions, dosages, refills, interactions and allergies, to suggest alternative medications and answer questions.
• Maintains current knowledge of pharmacy systems technology (e.g., workflows, prescription fulfillment, billing, clinical documentation, training, inventory management, and POS registers).
• Processes insurance claims. Liaises with insurance companies, medical providers and auditors.
• Develops and maintains relationships with the local medical community, including physicians, nurses, and other healthcare providers. Participates in community outreach activities to promote the pharmacy business and enhance growth opportunities. Participates in community events that reflect the unique communities we serve as requested by leadership team.
• Drives compliance and continuous improvement in the delivery of clinical pharmacy patient care and services by studying, evaluating, and re-designing processes; monitoring and analyzing results; and implementing changes. Adheres to regulatory compliance and standard operating procedures.
• Maintains awareness of third-party pharmacy business opportunities and assures proper administration and implementation of pharmacy systems and procedures.
• Seeks professional development and solicits feedback. Maintains current knowledge and required licensing/credentialing/certification as established by federal and state regulations. Stays current with pharmacy trends and best practices.

About Walgreens
Founded in 1901, Walgreens (www.walgreens.com) proudly serves nearly 9 million customers and patients each day across its approximately 8,500 stores throughout the U.S. and Puerto Rico. Walgreens has approximately 220,000 team members, including nearly 90,000 healthcare service providers, and is committed to being the first choice for pharmacy, retail and health services, building trusted relationships that create healthier futures for customers, patients, team members and communities.

Basic Qualifications

• BS in Pharmacy or Pharmacist Degree from an accredited educational institution.
• Current Pharmacist license as granted by the appropriate state licensing authority.
• Experience performing prescription dispensing activities, demonstrating a strong working knowledge of applicable state and federal controlled substance laws.
• Certified Immunizer or willing to become an immunizer within 90 days of hire.
• Willing and able to work effectively in different and/or multiple work environments (such as
• Centralized Services, Retail Pharmacy, Specialty Pharmacy, and/or virtual).

Preferred Qualifications

• At least 1 year of pharmacy experience, including prescription filling and verification, records and legal compliance, pharmacy operations, pharmacy software and technology systems and insurance.
• Experience using time management skills such as prioritizing/organizing and tracking details and meeting deadlines of multiple projects with varying completion dates.
• Experience with pharmacy technology including Intercom, Promise, and Plus.
• Has completed specialized training regarding medication and disease state or has sufficient practical experience necessary to provide specialized services offered at clinic location (HIV, Organ Transplant, Oncology, etc.).

Clarksville, Gallatin, Lawrenceburg, Manchester, Murfreesboro, Nashville

We will consider employment of qualified applicants with arrest and conviction records.

The Salary below is being provided to promote pay transparency and equal employment opportunities at Walgreens. The actual hourly salary within this range that you will be offered will depend on a variety of factors including geography, skills and abilities, education, experience and other relevant factors. This role will remain open until filled. To review benefits, please click here jobs.walgreens.com/benefits. If you are applying on a job board or unable to click on the link, please copy and paste this URL into your browser jobs.walgreens.com/benefits