Senior Specialty Benefits Navigator

Big Leap Health

6d • $63,000 - $80,000 • Remote

About The Position

Big Leap Health is seeking a proactive and solutions-oriented Senior Specialty Benefit Navigator to manage prior authorizations, pharmacy logistics, clinical protocols, and payer requirements. This role is crucial for ensuring patients have seamless access to vital treatments like Spravato and TMS. The navigator will resolve escalated prior authorization challenges, optimize patient coverage, streamline pharmacy fulfillment, and collaborate with payers and PBMs. This position acts as a key point of intervention to overcome obstacles and maintain 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

• Lead end-to-end resolution of complex prior authorizations, denials, step therapy overrides, tier exceptions, continuation-of-therapy, and reauthorization timelines.
• Determine the correct coverage path across medical vs. pharmacy benefits, including formulary status, HCPCS/CPT coding, site-of-care, and specialty classification; advise partners on buy-and-bill vs. pharmacy fulfillment.
• 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.
• 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.
• Maintain precise status, outcomes, and next steps in EHR/CRM/Airtable; ensure audit-ready records across all cases.
• Coach BPO team members, perform case QA, and contribute to SOPs, checklists, and templates.
• Track payer behavior and bottlenecks, propose fixes, and partner with leadership on process and tooling improvements.

Benefits

• Competitive Salary: An annual salary range of $60,000 - $70,000.
• Meaningful Equity: A stock option package.
• Comprehensive Health Coverage: A full benefits package that includes high-quality medical, dental, and vision insurance.
• Remote Work: This is a full-time, remote position for U.S.-based candidates operating on an Eastern Time (ET) schedule.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed