Medical Eligibility Specialist Job Description

Updated on: June 4, 2019

Position Overview

A medical eligibility specialist is usually hired by government organizations in order to help determine patients’ eligibility for specific programs.

For instance, it is the duty of a person working at this position to ensure that a disabled individual gets benefits, such as free medical services.


Besides, a medical eligibility specialist should be able to establish effective working relationships with clients and advocates and handle challenging interactions with great tact.

Position Requirements

To work as a medical eligibility specialist, you have to possess a high school diploma or a GED equivalent.

Previous experience in a related area comes in handy.

Working as a medical eligibility specialist can be complicated, as there is a lot of insightful work that you have to do.


Analyzing applications to determine if they meet eligibility requirements is one of the main areas of this work. And one has to be well-versed in it.

See also:

  1. Medical Eligibility Specialist Resume
  2. Sample Medical Eligibility Specialist Cover Letter


Medical Eligibility Specialist Job Description

• Read and analyze applications, and independently determine initial, as well as ongoing medical eligibility parameters.

• Conduct interviews over the telephone, and in person in order to obtain information for documenting purposes.

• Respond to queries and concerns regarding eligibility criteria from patients and advocates.

• Obtain pertinent financial and personal information through correspondence and in-person meetings.

• Evaluate data and extract information that is required to determine medical services eligibility.

• Process all applications in sync with the specifics outlined by the management.

• Review medical records and interact with family members and caregivers in order to acquire further information regarding different cases.

• Set eligibility parameters, and attempt to place clients/patients into them.

• Provide information such as services and community resources appropriate for each case.

• Select the right candidates for each program, and connect them with program heads or representatives.

• Oversee the delivery of financial aid to clients, ensuring that timelines are respected.

• Handle fact-checking tasks, in order to provide appropriate sync between people and resources.

• Play the role of a counselor on matters associated with aid programs.

• Create and maintain files and records of clients and confidentially save them.

• Follow up on assigned cases, to ensure timely and accurate delivery of services.

• Keep track of client appointments and ensure that appropriate client follow-up is managed.


Additional Resources

  1. Medical Eligibility Specialist Skills
  2. Sample Medical Eligibility Specialist Interview

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