Senior Specialty Benefits Navigator

Big Leap Health

Senior Specialty Benefits Navigator at Big Leap Health ensuring patient access to innovative mental health therapies. Navigating prior authorizations and fostering collaboration with payers and providers for seamless support.

Posted 6/29/2026full-timeNew York City • New York • 🇺🇸 United StatesSenior💰 $70,000 - $80,000 per yearWebsite

About the role

Key responsibilities & impact

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

What you’ll need

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.

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools

Case ManagementRevenue Cycle ManagementICD-10 CriteriaStep TherapyPrior Authorizations

Soft Skills

Clear CommunicationSolution-Focused MindsetSelf-Directed Work EthicAbility to Manage Competing Priorities