ZipRecruiter

Log In

1

Medical Eligibility Jobs (NOW HIRING)

Pyramid Consulting

Eligibility Representative

$19 - $19.35/hr

Employee benefits include, but are not limited to, health insurance (medical, dental, vision ... Process and maintain eligibility and enrollment transactions, including updates, corrections, and ...

Waikiki Health

Eligibility Specialist

Honolulu, HI · On-site

$21/hr

Eligibility Specialist Founded in 1967, Waikiki Health is a nonprofit, Federally Qualified Health ... Waikiki Health's mission is to provide quality medical and social services that are accessible and ...

CVS Health

Eligibility Consultant

East Lansing, MI · On-site

$19.25 - $26/hr

The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional ...

State of North Dakota

Eligibility Worker

Williston, ND · On-site

$22.33 - $29.78/hr

Eligibility Worker example of duties: * Conduct interviews of applicants and recipients * Process ... North Star Human Service Zone team members are offered robust medical, dental and life insurance ...

State of North Dakota

Eligibility Worker

Williston, ND · On-site

$19.50 - $26.50/hr

Eligibility Worker example of duties: * Conduct interviews of applicants and recipients * Process ... North Star Human Service Zone team members are offered robust medical, dental and life insurance ...

Savista

Eligibility Specialist

Phoenix, AZ · On-site

The Eligibility Specialist I is a critical advocate for patients, helping uninsured and ... Identify and assist with technical medical requirements for disability programs, including setting ...

Waikiki Health

Eligibility Specialist

Honolulu, HI · On-site

$21/hr

Eligibility Specialist Founded in 1967, Waikiki Health is a nonprofit, Federally Qualified Health ... Waikiki Health's mission is to provide quality medical and social services that are accessible and ...

State of North Dakota

Eligibility Worker

Bismarck, ND · On-site

$22.38 - $24.17/hr

Eligibility Worker example of duties: * Conduct interviews of applicants and recipients * Process ... Burleigh County Human Service Zone team members are offered robust medical, dental and life ...

previous page

Showing results 41-60

All JobsGovernment JobsMedical Eligibility Jobs

Medical Eligibility information

See salary details

$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

Eligibility Specialist

Community Health Systems, Inc.

Riverside, CA

Full-time

Re-posted 22 days ago

Community Health Systems rating

6.9

Company rating: 6.9 out of 10

Based on 276 frontline employees who took The Breakroom Quiz

456th of 888 rated healthcare providers

Job description

JOB SUMMARY:

The Eligibility Specialist has the responsibility for reviewing patients' insurance to verify their eligibility for qualifying insurance coverage prior patient's visit and updating the insurance information into patients' profile. This position will assist the management team with oversight of both the patient eligibility and patient application processes by serving as a liaison between the client and other departments.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

  • Determine if re-authorization needed for new order
  • Verify insurance eligibility
  • Call insurance companies to ascertain pertinent information regarding policies and payment benefits for patient
  • Instruct patients on amounts covered under benefits plan in easy to understand terminology
  • Retain strong medical terminology understanding in effort to better comprehend procedures
  • Follow Specific security rules and guidelines to protect sensitive data, including patient medical records and payment card information
  • Sign payment approvals accepted claims
  • Update all patient and insurance data regularly and carefully inputted changes into company's computer system
  • Handle billing related activities focused on medical specialties
  • Examine claims, records and procedures to grant approval of coverage
  • Check documentation for appropriate coding, catching errors and making revisions
  • Verify that patient had proper insurance coverage prior to any procedures or appointment scheduling
  • Create and maintain accurate and confidential patient files according to regulatory mandates
  • Update patient financial information to promote accurate record keeping
  • Perform all other duties as directed either formally or informally, verbally or in writing

SUPERVISORY RESPONSIBILITIES:

No direct supervisory responsibilities

KNOWLEDGE, SKILLS AND ABILITIES:

  • Working knowledge of medical terminology.
  • Must be able to work independently while utilizing strong critical thinking/time management skills.
  • Must be able to type 45 words per minute.
  • Strong computer skills, with proficiency in Microsoft Office.
  • Must possess good "customer service" including verbal and written communication.
  • A high standard of professionalism and professional ethics and conduct is expected in speech, manner, attitude and appearance at all times.
  • Possess strong interpersonal skills and ability to work well with others.
  • Ability to deal effectively with changing situations and stressful environment.
  • Ability to perform tasks related to physical activity to complete the responsibilities of the position

EXPERIENCE AND EDUCATION:

  • High School graduate or equivalent
  • Associate's Degree in a related field and/or Medical Billing Certificate from an accredited school preferred
  • Minimum 1 year of experience in medical billing, medical insurance and/or customer service

What Community Health Systems employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply