Big Leap Health

• Submit new provider enrollments with Medicare, Medicaid, and major commercial payers (e.g., BCBS, UHC, Aetna, Cigna) • Proactively track provider enrollment and credentialing statuses with Medicare, Medicaid, and major commercial payers (e.g., BCBS, UHC, Aetna, Cigna) • Request and follow up on payer fee schedules to support internal planning • Maintain and update CAQH, PECOS, NPPES, and state portals; resolve discrepancies and follow-up requests quickly • Maintain up-to-date payer status logs; report in real time on turnaround times, expirations, and pending items utilizing tracking tools • Collaborate with credentialing team members and liaise with payer representatives to escalate issues, unblock delays, and shorten approval timelines

Role Description 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. Key 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. Qualifications - 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. Requirements - You’re not just checking boxes—you’re the reason patients get access to care when bureaucracy says “no.” - You ensure that providers, partners, and payers have the information they need, when they need it, to keep treatment moving forward. Benefits - Competitive Salary: An annual salary range of $60,000 - $70,000, 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.

• Submit fee schedule requests to Medicare, Medicaid, and commercial payers (e.g., BCBS, UHC, Aetna, Cigna) across NY, NJ, CA, TX, FL, PA, CO, WI, WA, MD, and MO. • Follow up persistently with payer representatives by phone and email to obtain written copies of confirmed rates and resolve information gaps. • Verify that all requests include the correct CPT codes, provider NPIs, tax IDs, and any other payer-required identifiers to ensure accurate and timely fee schedule retrieval. • Log detailed, accurate status updates in our tracking systems in real time so the internal team always has current visibility. • Flag discrepancies, missing rates, or unusual findings clearly, with enough context for the team to act. • Collaborate with credentialing and billing team members to prioritize requests and escalate stalled items.