Eligibility worker vs medicaid specialist

The differences between eligibility workers and medicaid specialists can be seen in a few details. Each job has different responsibilities and duties. It typically takes 1-2 years to become both an eligibility worker and a medicaid specialist. Additionally, a medicaid specialist has an average salary of $44,308, which is higher than the $38,510 average annual salary of an eligibility worker.

The top three skills for an eligibility worker include public assistance programs, social services and medical assistance. The most important skills for a medicaid specialist are patients, home health, and medicaid eligibility.

Eligibility worker vs medicaid specialist overview

	Eligibility Worker	Medicaid Specialist
Yearly salary	$38,510	$44,308
Hourly rate	$18.51	$21.30
Growth rate	-	-
Number of jobs	19,954	73,368
Job satisfaction	-	-
Most common degree	Bachelor's Degree, 53%	Bachelor's Degree, 53%
Average age	46	46
Years of experience	2	2

What does an eligibility worker do?

An eligibility worker is in charge of determining an individual's eligibility for social services and benefits such as financial and housing aid. Their responsibilities include gathering and reviewing applications, conducting interviews and assessments, and coordinating with various agencies to arrange services. They also assist individuals by understanding and identifying their needs, answering inquiries, referring them to services and other agencies, helping them fill out forms and other requirements, and updating them with the progress of their applications.

What does a medicaid specialist do?

A Medicaid Specialist is a social service worker who focuses on assisting individuals when it comes to Medicaid programs. They are responsible for helping individuals understand the health care system procedures and requirements, answering inquiries, or referring them to other services. There are also Medicaid specialists who mostly perform clerical support tasks such as gathering and verifying documents, conducting research and analyses, handling calls and correspondence, reaching out to medical facilities and insurance companies, and maintaining records.

Eligibility worker vs medicaid specialist salary

Eligibility workers and medicaid specialists have different pay scales, as shown below.

	Eligibility Worker	Medicaid Specialist
Average salary	$38,510	$44,308
Salary range	Between $30,000 And $48,000	Between $29,000 And $67,000
Highest paying City	Urban Honolulu, HI	-
Highest paying state	New Jersey	-
Best paying company	County Of Los Angeles Public Library	-
Best paying industry	Professional	-

Differences between eligibility worker and medicaid specialist education

There are a few differences between an eligibility worker and a medicaid specialist in terms of educational background:

	Eligibility Worker	Medicaid Specialist
Most common degree	Bachelor's Degree, 53%	Bachelor's Degree, 53%
Most common major	Business	Business
Most common college	Northwestern University	University of Michigan - Ann Arbor

Eligibility worker vs medicaid specialist demographics

Here are the differences between eligibility workers' and medicaid specialists' demographics:

	Eligibility Worker	Medicaid Specialist
Average age	46	46
Gender ratio	Male, 18.4% Female, 81.6%	Male, 16.7% Female, 83.3%
Race ratio	Black or African American, 15.8% Unknown, 4.3% Hispanic or Latino, 24.3% Asian, 10.6% White, 43.5% American Indian and Alaska Native, 1.4%	Black or African American, 21.6% Unknown, 4.2% Hispanic or Latino, 14.7% Asian, 7.8% White, 50.5% American Indian and Alaska Native, 1.2%
LGBT Percentage	7%	7%

Differences between eligibility worker and medicaid specialist duties and responsibilities

Eligibility worker example responsibilities.

Calculate and determine benefits and renewals for applicants to state entitlement programs, CalFresh and Medi-Cal.
Greet the clients when they come to apply to foodstamps, calworks or medical.
Interview clients for food stamps, TANF and Medicaid to see if they are eligible to receive benefits.
Plan, implement and coordinate programs and services to TANF recipients and their family members in order to promote self-sufficiency.
Carry all the cases for the entire county of individuals who are self employ but still eligible for Calworks and/or foodstamps.
Gather require information and documentation to determine eligibility in the Medi-Cal program while implementing policies and regulations.

Medicaid specialist example responsibilities.

Generate reports for managing compliance with Medicaid documentation in support of electronic billing to MCO
Acquire valuable expertise of HIPAA, Medicaid and patient confidentiality.
Provide excellent compassionate customer service to all patients, honoring patient privacy according to HIPAA regulations.
Review referrals and screen all uninsure patients seen at contract HCA hospitals for potential Medicaid and/or disability eligibility.
Adhere to all HIPPA laws.
Ensure ICD-9-CM, CPT, and HCPCS codes are correct for billing.

Eligibility worker vs medicaid specialist skills

Common eligibility worker skills

Public Assistance Programs, 10%
Social Services, 8%
Medical Assistance, 8%
Medi-Cal, 7%
Customer Service, 6%
Computer System, 5%

Common medicaid specialist skills

Patients, 23%
Home Health, 13%
Medicaid Eligibility, 13%
Rehabilitation, 9%
Social Work, 5%
Term Care, 4%

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Eligibility Worker vs Medicaid Specialist

Updated January 8, 2025

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