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Medical Eligibility Jobs (NOW HIRING)

Arizona Department of Administration

$24.68/hr

Phoenix Medical Eligibility Assessor Job No: 542744 Work Type: Full-time Location: REMOTE OPTIONS, PHOENIX Categories: Social Work/Human Services AHCCCS Arizona Health Care Cost Containment System ...

Mobile Vision Partners PLLC

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Medical Eligibilty Office Staff

Clearwater, FL · On-site

$19/hr

We are looking for a full time office Medical Eligibility/ clerical person. Must have knowledge of running medical eligibilities for an Optical office. Answer phones and emails. Company Description ...

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Vergence Group

RN Specialist

Indianapolis, IN · On-site

$38/hr

Medical Eligibility And Prior Authorization Specialist Pay: $38.00/hour Part-time, Hybrid position in Indianapolis In this role you will determine medical eligibility and provide prior authorization ...

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Medical Eligibility information

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$33K

$52.2K

$71K

How much do medical eligibility jobs pay per year?

As of Aug 18, 2026, the average yearly pay for medical eligibility in the United States is $52,156.00, according to ZipRecruiter salary data. Most workers in this role earn between $46,000.00 and $60,000.00 per year, depending on experience, location, and employer.

What is a medical eligibility specialist?

A Medical Eligibility Specialist is a professional who determines whether individuals qualify for public health programs or medical benefits based on specific eligibility criteria. They review applications, verify documentation, and ensure that applicants meet the guidelines established by government or insurance programs. These specialists often interact with clients to collect information, explain program requirements, and assist with the application process. Their work is crucial for connecting people to the healthcare services they need.

What are the key skills and qualifications needed to thrive as a medical eligibility specialist?

To thrive as a Medical Eligibility Specialist, you need comprehensive knowledge of healthcare programs, eligibility requirements, and strong analytical skills, often supported by a background in health administration or a related field. Familiarity with case management systems, healthcare databases, and government benefit platforms is essential for accurate assessment and documentation. Excellent attention to detail, strong communication, and empathy are crucial soft skills for interacting effectively with applicants and colleagues. These skills ensure correct eligibility determinations, efficient case processing, and positive client experiences in a highly regulated environment.

What are some common challenges faced by professionals in medical eligibility roles, and how can they be managed?

Professionals in Medical Eligibility often encounter challenges such as interpreting complex insurance policies, staying updated with frequent regulatory changes, and handling high volumes of case reviews under tight deadlines. Effective communication with healthcare providers, insurance companies, and patients is crucial to resolve discrepancies and ensure accurate eligibility determinations. Staying organized, investing time in continuous training, and utilizing updated software tools can help manage these challenges and improve workflow efficiency.

What is the difference between Medical Eligibility vs Medical Assistant?

AspectMedical EligibilityMedical Assistant
Required CredentialsTypically requires a high school diploma or equivalent; some roles may need certification in medical eligibility assessmentHigh school diploma or equivalent; certification preferred but not always required
Work EnvironmentHealthcare settings, insurance companies, government agenciesClinics, hospitals, physician offices
Employer & Industry UsageUsed by insurance providers, healthcare agencies to determine patient coverageEmployers in healthcare to assist with patient care and administrative tasks

Medical Eligibility specialists focus on assessing patient qualifications for insurance coverage or benefits, often working in insurance or healthcare agencies. Medical Assistants support clinical and administrative tasks in healthcare facilities. While both roles require healthcare knowledge, Medical Eligibility roles emphasize eligibility assessment, whereas Medical Assistants focus on patient care and office support.

More about Medical Eligibility jobs

What states have the most Medical Eligibility jobs?

States with the most job openings for Medical Eligibility jobs include:

What job categories do people searching Medical Eligibility jobs look for?

The top searched job categories for Medical Eligibility jobs are:

Medical Eligibility jobs near you

Chinle Medical Eligibility Assessor

The State of Arizona

Remote

$27.88/hr

Full-time

Medical, Dental, Life, Retirement, PTO

Posted 16 days ago

State Of Arizona rating

7.7

Company rating: 7.7 out of 10

Based on 101 frontline employees who took The Breakroom Quiz

24th of 50 rated states

Job description

Chinle Medical Eligibility Assessor

Apply now Job No: 542742
Work Type: Full-time
Location: REMOTE OPTIONS, CHINLE
Categories: Social Work/Human Services

AHCCCS Arizona Health Care Cost Containment System
The Arizona Health Care Cost Containment System (AHCCCS), Arizona's Medicaid agency,
is driven by its mission to deliver comprehensive, cost-effective health care to Arizonans in need.
We're Hiring!
Chinle Medical Eligibility Assessor Arizona Health Care Cost Containment System Division of Member and Provider Services Tseyi Shopping Center, Hwy. 191 Chinle, Arizona 86503 https://www.ahcccs.gov
Salary: $27.8770 Hourly
Flexible Work Options: Remote within Arizona
Requisition Closing Date: August 16, 2026

Make An Impact With AHCCCS
AHCCCS is nationally recognized for its outstanding workplace effectiveness and flexibility, consistently setting the benchmark for excellence among Medicaid programs. AHCCCS employees are deeply committed to serving Arizona's citizens, ensuring access to quality healthcare for vulnerable populations.

Why AHCCCS?
At AHCCCS, your work doesn't just support a system-it transforms lives across Arizona.
Supportive Culture: High employee engagement, strong leadership, and flexible work options including remote roles.
Diverse Career Paths: Whether you're an experienced professional, a recent graduate, or exploring internships, AHCCCS offers meaningful roles in a competitive industry.
Innovation in Public Service: Join a team that values performance, creativity, and continuous improvement in delivering healthcare solutions.

What You'll Do
As a Medical Eligibility Assessor, you'll:
Conduct Pre-Admission Screenings (PAS) determining medical eligibility for Arizona Long Term Services (ALTCS)
Review medical records
Record and update actions taken on case files
Directly interact with customers
Travel to various off-site locations

Your Competencies and Skills
We're looking for someone who can:
Perform comprehensive interactive Pre-Admission Screenings for all age groups in various settings.
Determine Medicaid eligibility based on medical records, health conditions, and treatment history.
Ensure compliance with Medicaid guidelines, state, and federal laws.
Prepare and submit medical assessment results accurately and on time.
Provide community resources for customers not eligible.
Recognize improvement opportunities in medical assessments.
Stay current on Medicaid rules and regulations.

What We Need From You
Required Qualifications:
Meet one of the following: 2 years in medical case management, RN licensure, or a relevant degree.
Bilingual (fluent) in Navajo
Valid Driver's License
Pass a Fingerprint Background Screening
Complete E-Verify employment eligibility
Attend required training at start of employment

What Sets You Apart
Preferred Qualifications:
Background in medical case management
Licensure as a Registered Nurse
Professional experience working with the elderly or disabled

The Perks
Join us, and you'll enjoy:
Comprehensive medical, dental, and life insurance options
Supportive retirement plan through Arizona State Retirement System (ASRS)
10 paid holidays and generous vacation/sick leave
Up to 12 weeks of paid parental leave (pilot program)
Tuition reimbursement, wellness plans, and professional development
Flexible schedules to support work-life balance
Visit the State of Arizona benefits page for more

Are You Ready to Make a Difference?
Take the next step in your career and join a team that's transforming lives across Arizona.
Apply today and be part of something extraordinary!
For questions, contact AHCCCS Careers at 6024174000 or careers@azahcccs.gov

Additional Details
Applications are reviewed on a rolling basis-apply early to ensure consideration!
Travel within Arizona may be required for this role.

Advertised: 31 Jul 2026 US Mountain Standard Time
Applications close: 16 Aug 2026 US Mountain Standard Time

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About State of Arizona

Sourced by ZipRecruiter

State of Arizona is not a conventional company, but the governmental structure presiding over the U.S. state of Arizona, headquartered in Phoenix, AZ. The State of Arizona operates within the industry of government administration and public services across various sectors including education, health, public safety, transportation, and economic services. These services are aimed to ensure the security, prosperity, and well-being of the Arizona citizens and communities. Founded on February 14, 1912, when Arizona became the 48th state to join the Union, the State of Arizona is committed to providing people-centric, efficient, and effective government. Its mission is to improve the quality of life for all Arizonans by providing a secure environment and advancing the state's economy.

Industry

Public administration

Company size

10,000+ Employees

Headquarters location

Phoenix, AZ, US

Year founded

1912

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