Senior Specialty Benefits Navigator (New York City)
About The Position
Big Leap Health is seeking a proactive and solutions-oriented Senior Specialty Benefit Navigator to ensure seamless patient access to vital treatments, including cutting-edge depression therapies like Spravato and TMS. This role involves navigating prior authorizations, pharmacy logistics, clinical protocols, and payer requirements. The ideal candidate will resolve escalated prior authorization challenges, optimize patient coverage, streamline pharmacy fulfillment, and collaborate with payers, PBMs, and partners. This position is critical in 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
- Lead resolution of complex PAs, denials, step therapy overrides, tier exceptions, continuation-of-therapy, and reauthorization timelines to keep treatment on schedule.
- 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.
- 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.
- 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 $70,000 - $80,000, commensurate with your experience.
- Meaningful Equity: A stock option package
- Comprehensive Health Coverage: A full benefits package that includes high-quality medical, dental, and vision insurance
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
