Senior Specialty Benefits Navigator

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Big Leap Health

WebsiteLinkedInAll Job Openings

1 - 10 employees

🏪 Marketplace

⚕️ Healthcare Insurance

👥 B2C

Marketplace • Healthcare Insurance • B2C

Big Leap Health is a digital health marketplace that connects patients with insurance-covered, clinic-based mental health treatments—primarily Transcranial Magnetic Stimulation (TMS) and esketamine (Spravato). The platform helps users find in-network certified clinics, compare programs via virtual tours and testimonials, complete brief symptom assessments, and coordinate next steps with partner practices. Big Leap Health emphasizes access to vetted, psychiatrist-overseen, FDA-approved treatments covered by insurance and supports both patients and clinic partners.

📋 Description

• 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.

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

🏖️ Benefits

• Competitive Salary: An annual salary range of $60,000 - $70,000. • 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.