Find Jobs
Find Jobs Near You – Available Work in Your Location
Skip to job details
BS
Bayshire Senior Communities
Medi-Cal Eligibility Specialist
Career Insights for Eligibility Specialist
See where this job fits in the broader career landscape. Knowing your career path helps you see what's possible from here.
Scorecard
Based on California data
Review key factors to help you decide if this role fits your goals. How is this calculated?
What they do
An Eligibility Specialist provides assistance and information for people who apply for a government benefits program or health care program. Answers questions, assists with an application process, and reviews applications and relevant background information to determine eligibility. May assist eligible applicants with enrolling in a program.
$54,990 / year median in California
+4% projected growth
Job Description
The Medi-Cal Eligibility Specialist is responsible for identifying, resolving, and preventing Medi-Cal eligibility issues that impact residents' access to services or hinder reimbursement. This role ensures timely coordination of Medi-Cal redeterminations, collaborates with county eligibility offices, and supports residents through complex eligibility processes. The position is primarily in office, with required field visits to county Medi-Cal offices when in-person resolution is more effective. Responsibilities Investigate and resolve Medi-Cal eligibility barriers that prevent members from accessing services or disrupt reimbursement workflows. Conduct eligibility verification using state systems and Health insurance databases. Communicate with county eligibility workers to clarify case status and resolve pending or denied actions. Oversee and coordinate Medi-Cal redetermination submissions. Track redetermination cycles and proactively engage residents/residents resp party Contact residents/Resp Party to gather required information and explain eligibility requirements. Build relationships with county Medi-Cal offices. Maintain accurate, audit-ready documentation. Conduct in-person visits to county offices when necessary. Track and report eligibility trends and case outcomes. Driving will be required to county offices. Maintain confidentiality, HIPAA compliance, and knowledge of mandated reporting requirements. Performs other duties as assigned.