Senior Specialty Benefits Navigator

Big Leap Health

100d • $63,000 - $80,000

About The Position

We are seeking a proactive and solutions-oriented Senior Specialty Benefit Navigator, adept at navigating prior authorizations, intricate pharmacy logistics, clinical protocols, and evolving payer requirements. This role ensures seamless patient access to vital treatments, including cutting-edge depression therapies like Spravato and TMS, by expertly resolving escalated prior authorization (PA) challenges, optimizing patient coverage across medical and pharmacy benefits, streamlining complex pharmacy fulfillment workflows, and fostering direct collaboration with payers, PBMs, and partners. You are the critical point of intervention, transforming obstacles into actionable solutions and ensuring continuity of care.

Requirements

• 4-6+ years in a healthcare operations, case management, or revenue cycle role, preferably in behavioral health, specialty pharmacy, or prior authorization.
• Strong familiarity with payer policies, clinical documentation, and pharmacy workflows (e.g., step therapy, prior authorizations, ICD-10 criteria).
• Clear and concise communicator—written and verbal—with strong documentation skills.
• Proven ability to stay calm and solution-focused while juggling competing priorities.
• Self-directed with a 'get it done' mindset and high ownership over work product.

Nice To Haves

• Experience working with Spravato, TMS, or similar high-touch behavioral health treatments.

Responsibilities

• Own escalations end‑to‑end: Lead resolution of complex PAs, denials, step therapy overrides, tier exceptions, continuation‑of‑therapy, and reauthorization timelines to keep treatment on schedule.
• Navigate benefits expertly: Determine the correct coverage path across medical vs. pharmacy benefits, formulary status, HCPCS/CPT coding, site‑of‑care, and specialty classification; advise partners on buy‑and‑bill vs. pharmacy fulfillment.
• Direct payer/PBM advocacy: Conduct targeted outreach to plans and PBMs to expedite decisions, correct errors, and secure patient access; prepare and submit clinical criteria summaries and appeals packets as needed.
• Clinic and provider support: Interface with clinicians and partner staff to identify missing documentation, clarify criteria, and align on next steps; coordinate with pharmacies for shipment, copay confirmation, and consent.
• Documentation and systems: Maintain precise status, outcomes, and next steps in EHR/CRM/Airtable; ensure audit‑ready records across all cases.
• Quality and mentorship: Coach BPO team members, perform case QA, and contribute to SOPs, checklists, and templates.
• Insights and improvement: Track payer behavior and bottlenecks, propose fixes, and partner with leadership on process and tooling improvements.

Benefits

• Competitive Salary: An annual salary range of $63,000 - $80,000, commensurate with your experience and location.
• Meaningful Equity: A stock option package, because we believe everyone should have a stake in the success we're building together.
• Comprehensive Health Coverage: A full benefits package that includes high-quality medical, dental, and vision insurance to support your well-being.
• Remote Work: This is a full-time, remote position for U.S.-based candidates operating on an Eastern Time (ET) schedule.
• Mission-Driven Impact: The opportunity to play a critical role in a company dedicated to radically improving access to life-changing mental healthcare.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level