Top 6 Prior authorization nurse Jobs in Madison, Al

Referral Coordinator
HAPPI Health —Huntsville, AL
- $22 - $34 an hour
- Full-time
- Spanish
- Microsoft Excel
- Microsoft Outlook
- Health insurance
- Dental insurance
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Prior Authorization Manager
Clearview Cancer Institute —Huntsville, AL
- Full-time
- Nursing
- Mid-level
- Master's degree
Quick Apply
4d
Pre Cert Rep
Huntsville Hospital Health System —Madison, AL
- Full-time
- Writing skills
- HIPAA
- Mid-level
- Disability insurance
- Health insurance

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Prior Authorization Specialist
Clearview Cancer Institute —Huntsville, AL
This position requires that the employee be able to sit at a desk in front of a computer for up to eight hours a day. Must be organized and efficient.
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Prior Authorization Manager
Clearview Cancer Institute —Huntsville, AL
Required bachelor’s degree in nursing, pharmacy, or healthcare administration. Analyze complex medical information to assess the clinical necessity of requested…
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4d

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Referral Coordinator

HAPPI Health -
Huntsville, AL

Quick Apply

Job Details

Full-time
$22 - $34 an hour

Benefits

Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
Life insurance

Qualifications

Customer communication
Microsoft Excel
Microsoft Outlook
Customer service
HIPAA
Time management

Full Job Description

Job Summary:

The Referral Coordinator serves as a key member of the Patient Advocacy Team (PAT) by coordinating specialty referrals, insurance authorizations, and continuity of care services for HAPPI Health patients. This role acts as a liaison between patients, providers, specialists, hospitals, and insurance companies to ensure patients receive timely access to recommended healthcare services.

The Referral Coordinator is responsible for managing referral workflows from initiation through completion, maintaining accurate documentation within the electronic health record, communicating referral updates to patients and providers, and collaborating with multidisciplinary teams to reduce barriers to care. This position plays a vital role in supporting patient-centered care through effective communication, organization, and care coordination.

Essential Job Responsibilities

Coordinate specialty referrals from provider order through referral completion.
Review referral orders for accuracy and ensure all required documentation is obtained prior to submission.
Submit insurance referrals and authorizations in accordance with payer guidelines, including Medicaid, Medicare, Tricare, BCBS, UnitedHealthcare, and other commercial insurance plans.
Maintain accurate referral documentation within the electronic health record (Athenahealth).
Communicate referral status and next steps to patients, providers, and specialty offices.
Respond to incoming calls, portal messages, and referral correspondence in a timely and professional manner.
Monitor referral work queues and follow up on pending referrals, incomplete documentation, and outstanding patient care needs.
Review consult notes and attach clinical documentation to the appropriate referral orders.
Coordinate hospital and emergency room follow-up activities as assigned.
Collaborate with providers, nursing staff, medical assistants, clinical support staff, and external healthcare partners to promote continuity of care.
Identify and resolve barriers that may delay patient access to specialty care.
Maintain compliance with organizational policies, payer requirements, HIPAA regulations, and applicable healthcare standards.
Participate in departmental process improvement initiatives and workflow development.

Key Skills & Qualifications

Strong understanding of referral coordination and continuity of care within a healthcare setting.
Working knowledge of medical insurance plans, payer guidelines, and referral/authorization requirements.
Proficiency with electronic medical record (EMR/EHR) systems; Athenahealth experience preferred.
Excellent organizational and time management skills with the ability to prioritize multiple tasks in a fast-paced environment.
Strong written and verbal communication skills with the ability to communicate effectively with patients, providers, specialists, and insurance representatives.
Ability to review documentation for completeness and identify missing information that may delay patient care.
Strong problem-solving and critical thinking skills with the ability to resolve referral barriers and coordinate appropriate follow-up.
Ability to work independently while collaborating effectively within a multidisciplinary healthcare team.
Proficiency in Microsoft Office Suite (Outlook, Word, Excel) and general computer applications.
Commitment to providing exceptional customer service with a patient-centered approach.
Ability to maintain patient confidentiality and comply with HIPAA regulations.

Qualifications

Licensed Practical Nurse or Certified Medical Assistant Required
Previous experience in a referral coordination or care coordination role, preferably within a federally qualified healthcare center.
Knowledge of healthcare systems, insurance processes, and referral management.
Strong communication skills, both verbal and written, with the ability to communicate effectively with patients, providers, and other staff.
Ability to work independently and as part of a multidisciplinary team.
Proficiency in using Electronic Health Record (EHR) systems and other relevant healthcare software.
Familiarity with the specific needs and populations served by Federally Qualified Healthcare Centers is preferred.
Bilingual skills (e.g., Spanish) are a plus.
Athena experience preferred.

Work Environment

This position operates in a healthcare clinic environment with moderate noise levels and potential exposure to patients with infectious conditions.
Flexibility in work schedule may be required based on the needs of the healthcare center.

Job Type: Full-time

Pay: $22.00 - $34.00 per hour

Benefits:

401(k)
Dental insurance
Health insurance
Life insurance
Paid time off
Vision insurance

Work Location: In person

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prior authorization nurse jobs in madison, al

Referral Coordinator

Prior Authorization Manager

Pre Cert Rep

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