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Medix

Medicaid Eligibility Specialist

Nyack, NY · On-site

$22 - $24/hr

Experience working within a hospital or healthcare system. * Knowledge of Medicaid eligibility and financial assistance processes. * Excellent communication, customer service, and interpersonal ...

State of North Dakota

Eligibility Worker

Minot, ND · On-site

$3.6K - $4.2K/mo

... Care, Medicaid, or Low Income Home Energy Assistance Programorcompletion of the eligibility worker two year associate degree program. Eligibility Worker Technician: If unable to fill as an ...

New

State of North Dakota

Eligibility Worker

Dickinson, ND · On-site

$3.6K - $4.3K/mo

... Medicaid, Low Income Home Energy Program, or completion of the eligibility worker two-year associate degree program. Eligibility Worker Technician: If unable to fill as an Eligibility Worker, we will ...

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How much do medicaid eligibility worker jobs pay per hour?

As of Sep 6, 2026, the average hourly pay for medicaid eligibility worker in the United States is $22.65, according to ZipRecruiter salary data. Most workers in this role earn between $19.23 and $25.96 per hour, depending on experience, location, and employer.

What is a Medicaid Eligibility Worker?

Medicaid Eligibility Workers are professionals who help individuals and families determine if they qualify for Medicaid, a government health insurance program for low-income people. They review applications, verify documents, and assess financial and personal information to make eligibility decisions. These workers also explain Medicaid rules, assist applicants through the enrollment process, and may help clients access other social services. Their role is essential in ensuring that those who qualify receive the healthcare coverage they need.

What skills and qualifications are needed to be a Medicaid Eligibility Worker?

To thrive as a Medicaid Eligibility Worker, you need a solid understanding of Medicaid regulations, eligibility criteria, and case management, often supported by a high school diploma or associate degree. Familiarity with case management software, state eligibility systems, and document verification tools is typically required. Strong organizational skills, attention to detail, and effective communication are vital soft skills for interacting with clients and managing complex cases. These abilities ensure accurate eligibility determinations, timely service delivery, and positive client experiences.

What challenges do Medicaid Eligibility Workers face when determining applicant eligibility?

Medicaid Eligibility Workers often encounter challenges such as navigating complex state and federal regulations, handling incomplete or inconsistent documentation from applicants, and managing high caseloads with tight deadlines. Staying updated on frequent policy changes is essential, as rules can vary across jurisdictions and programs. Effective communication skills are also crucial, since workers must explain eligibility requirements clearly to applicants from diverse backgrounds while maintaining confidentiality and accuracy throughout the process.

What is the difference between Medicaid Eligibility Worker vs Medicaid Case Manager?

AspectMedicaid Eligibility WorkerMedicaid Case Manager
CredentialsHigh school diploma or equivalent; some roles may require certificationHigh school diploma; some roles may require certification or experience in case management
Work EnvironmentOffice settings, community outreach, government agenciesOffice-based, community visits, healthcare facilities
Employer & IndustryState and local government agencies, Medicaid officesHealthcare providers, social service agencies, Medicaid programs
Search & Comparison IntentUnderstanding roles, job requirements, and differencesComparing responsibilities, qualifications, and work settings

Medicaid Eligibility Workers primarily focus on determining eligibility for Medicaid benefits, working within government agencies. Medicaid Case Managers, on the other hand, provide ongoing support and coordinate care for Medicaid recipients. While both roles involve Medicaid, Eligibility Workers handle application processing, whereas Case Managers focus on case oversight and service coordination.

More about Medicaid Eligibility Worker jobs

What states have the most Medicaid Eligibility Worker jobs?

States with the most job openings for Medicaid Eligibility Worker jobs include:

What job categories do people searching Medicaid Eligibility Worker jobs look for?

The top searched job categories for Medicaid Eligibility Worker jobs are:

Medicaid Eligibility Worker jobs near you
Infographic showing various Medicaid Eligibility Worker job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 18% Part Time, and 3% Contract. Highlights an 96% Physical, 1% Hybrid, and 3% Remote job distribution, with an average salary of $47,119 per year, or $22.7 per hour.

Medicaid Eligibility Specialist

Jordan Valley Health

Springfield, MO • On-site

Full-time

Medical, Dental, Vision, Life, Retirement

Re-posted 8 days ago

Job description

Description

About Jordan Valley Health:


Jordan Valley Health (JVH) is a mission-driven organization dedicated to improving the health of individuals and families in underserved communities. We provide comprehensive healthcare services including primary medical, dental, vision, and behavioral health. Our mission is simple: Improve our community's health through access and relationships. By working collaboratively with partners and continually innovating, JVH strives to be a leader in providing essential healthcare for the underserved, ensuring everyone in our community has access to quality healthcare.


Job Summary:


The Medicaid Eligibility Specialist serves as an advanced resource for Medicaid eligibility, enrollment, and case resolution activities. This position is responsible for reviewing complex cases, resolving escalated issues, providing technical guidance to front-line staff, and ensuring compliance with state and federal Medicaid regulations. The Medicaid Eligibility Specialist acts as a subject matter expert and liaison between eligibility staff, managed care organizations, providers, and state agencies to support timely and accurate access to Medicaid benefits. Medicaid Eligibility Specialist typically handle escalated eligibility determinations, renewals, changes, and complex case reviews requiring advanced knowledge of Medicaid policy and procedures. 


Key Responsibilities:

Eligibility and Case Resolution 

  • Review and process complex Medicaid applications, renewals, and case changes.  
  • Investigate and resolve escalated eligibility issues referred by Tier 1 staff or external stakeholders.  
  • Analyze income, household composition, residency, citizenship, and other eligibility factors to determine Medicaid eligibility.  
  • Complete redeterminations and eligibility corrections within established timeliness standards.  
  • Ensure compliance with all federal, state, and agency policies governing Medicaid eligibility. 

Technical Support and Escalations 

  • Serve as the primary escalation point for complex eligibility and enrollment inquiries.  
  • Research policy questions and provide guidance to Tier 1 staff.  
  • Assist with interpretation and application of Medicaid regulations and policy updates.  
  • Identify system issues and collaborate with technical teams to resolve eligibility-related concerns.  
  • Support quality assurance efforts by reviewing cases and identifying trends or training opportunities.  

Customer Service and Stakeholder Support 

  • Respond to  escalated member, provider, and community partner inquiries.  
  • Explain Medicaid eligibility decisions, enrollment requirements, and program benefits.  
  • Coordinate with healthcare providers, managed care organizations, and community agencies to facilitate access to services.  
  • Maintain professionalism and confidentiality when handling sensitive information.  

Training and Quality Improvement 

  • Mentor and train Tier 1 staff on eligibility processes and policy changes.  
  • Participate in quality audits and corrective action initiatives.  
  • Assist with development and maintenance of standard operating procedures.  
  • Recommend process improvements to increase efficiency, accuracy, and customer satisfaction.  

Documentation and Reporting 

  • Maintain accurate electronic case records and supporting documentation.  
  • Utilize eligibility and enrollment systems to document actions and track case activity.  
  • Generate reports and provide data related to workload, timeliness, and quality measures.  
  • Participate in audits and compliance reviews as required. 

Medicaid & Presumptive Eligibility 

  • Assist patients with Medicaid applications, renewals, and changes, including gathering required documentation. 
  • Determine and issue Presumptive Eligibility for Medicaid in compliance with state and federal guidelines. 
  • Clearly explain eligibility determinations, coverage timelines, and next steps to patients. 
  • Track and follow up on applications to ensure continuity of care and coverage. 

Teamwork & Organizational Goals 

  • Promote effective working relations and work as part of a team to facilitate the organization's ability to meet its goals and objectives. 
  • Attain all agreed-upon goals and objectives within specified time frames, contributing to the organization's overall mission. 
  • Consistently meet monthly individual productivity goals and key performance indicators (KPIs) as determined by Management. 

Compliance & Documentation 

  • Maintain accurate, timely documentation in the electronic health record (EHR) and eligibility systems. 
  • Ensure compliance with HRSA, Medicaid, and FQHC regulatory requirements. 
  • Protect patient confidentiality and comply with HIPAA and organizational privacy policies. 
  • Participate in internal audits, quality assurance activities, and compliance reviews as required. 
  • Stay current on changes to Medicaid, Presumptive Eligibility, and Sliding Fee Scale regulations. 
  • Responsibly follow the Clinic Exposure Control Plans, including protocols for Bloodborne and Airborne Pathogens. 
  • Demonstrate respect and regard for the dignity of all patients, families, visitors, and fellow employees to maintain a professional, responsible, and courteous environment. 
  • Provide metrics if needed to meet various GRANT funded initiatives 

Performance Expectations 

  • Maintain established productivity and timeliness standards.  
  • Achieve quality review scores of 95% or higher.  
  • Resolve escalated cases within established service-level agreements.  
  • Demonstrate expertise in Medicaid policy and serve as a resource to staff and stakeholders.  
  • Support agency goals related to access, enrollment accuracy, and customer satisfaction. 

Collaboration & Outreach 

  • Collaborate with registration, billing, care teams, case management, and leadership to support patient access. 
  • Refer patients to internal programs and external community resources, including housing, food assistance, transportation, and social services. 
  • Participate in outreach events, enrollment activities, and community engagement efforts as needed.
  • All other duties as assigned.


Benefits Overview:

  • Medical and Prescription Drug Coverage: Three comprehensive plan options (Buy-up, Base, and High Deductible) through UnitedHealthcare's Choice Plus network, covering various deductibles and out-of-pocket limits. Includes access to telemedicine services via Teladoc.
  • Health Savings Account (HSA): Available for employees in the High Deductible Plan with employer contributions and tax advantages.
  • Flexible Spending Account (FSA): Options for both healthcare and dependent care FSAs, allowing pre-tax contributions for qualified expenses.
  • Dental and Vision Coverage: Dental insurance through Cigna's DPPO network and vision coverage through EyeMed's Insight network.
  • Retirement Plan: Pre-tax and Roth 403(b) retirement plans with a 5% employer match starting after 30 days of employment.
  • Life and Disability Insurance: Basic Life and AD&D insurance provided at no cost, with the option to purchase additional coverage. Long-term and short-term disability insurance are also available.
  • Employee Assistance Program (EAP): Free confidential support for personal and professional challenges, including counseling and crisis intervention.
  • Additional Voluntary Benefits: Options for critical illness, accident, hospital care, and pet insurance through MetLife.
  • Pay on Demand Available
Holidays:
  • Nine paid holidays per year.

Health Requirements:


All employees are required to provide proof of vaccination for Flu, Hepatitis B and Tuberculosis (TB) as part of our commitment to maintaining a safe and healthy workplace.


Application Process:


Interested applicants should submit a resume and cover letter through the JVH career portal at Careers & Education - Jordan Valley. Applications will be accepted on a rolling basis until the position is filled.


Jordan Valley Health is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran, or disability status.

Requirements

Required Qualifications:

  • Minimum of three (3) years of experience in Medicaid eligibility, public assistance programs, patient access, insurance enrollment, or related field.
  • Experience interpreting policies and making independent eligibility determinations.   

Preferred Qualifications:

  • Associate's degree or relevant certification
  • Previous experience in an FQHC, community clinic, or safety-net healthcare setting 
  • EPIC, electronic health record experience preferred
  • Experience addressing social determinants of health.  

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