Senior Specialty Benefits Navigator
About reputed company: reputed company’s mission is to reputed company reputed company to mental reputed company by empowering clinics to easily launch and reputed company interventional psychiatry practices, specializing in cutting-edge treatments such as Spravato (esketamine) and Transcranial reputed company Stimulation (TMS). We're building a new reputed company of care by providing comprehensive operational, administrative, and clinical support, enabling psychiatrists to reputed company on delivering effective, life-changing treatments. Founded by industry leaders in mental health and reputed company technology, reputed company is backed by top-tier investors and driven by a commitment to radically improving patient reputed company through innovative therapies. Join us in pioneering the reputed company of mental health. About the Role: 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 reputed company 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 reputed company pharmacy fulfillment workflows, and fostering reputed company collaboration with payers, PBMs, and partners. You are the critical reputed company of reputed company, transforming obstacles into actionable solutions and ensuring continuity of care. Key Responsibilities: Own escalations end‑to‑end: reputed company reputed company of reputed company PAs, denials, reputed company therapy overrides, tier exceptions, continuation‑of‑therapy, and reauthorization timelines to reputed company treatment on schedule. Navigate benefits expertly: Determine the correct coverage reputed company across medical vs. pharmacy benefits, formulary status, HCPCS/CPT coding, site‑of‑care, and specialty classification; advise partners on buy‑and‑reputed company vs. pharmacy fulfillment. reputed company payer/PBM advocacy: Conduct targeted reputed company to plans and PBMs to expedite reputed company, correct errors, and secure patient reputed company; prepare and submit clinical reputed company summaries and appeals packets as needed. Clinic and provider support: reputed company with clinicians and partner staff to identify missing documentation, clarify reputed company, and reputed company on next steps; coordinate with pharmacies for shipment, copay confirmation, and consent. Documentation and systems: Maintain precise status, reputed company, and next steps in EHR/CRM/reputed company; ensure audit‑reputed company records across reputed company cases. reputed company and mentorship: reputed company BPO team members, reputed company case QA, and contribute to SOPs, checklists, and templates. Insights and improvement: reputed company payer behavior and bottlenecks, propose fixes, and partner with leadership on process and tooling improvements. What You Bring: 4-6+ years in a reputed company operations, case management, or reputed company cycle role, preferably in behavioral health, specialty pharmacy, or prior authorization Strong familiarity with payer policies, clinical documentation, and pharmacy workflows (e.g., reputed company therapy, prior authorizations, ICD-10 reputed company) reputed company and concise communicator—written and verbal—with strong documentation skills Proven ability to stay reputed company and solution-reputed company while juggling competing priorities Self-directed with a “get it done” reputed company and high ownership over work product Bonus: Experience working with Spravato, TMS, or similar high-touch behavioral health treatments Why This Role reputed company: You’re not just checking boxes—you’re the reason patients get reputed company to care reputed company bureaucracy says “no.” You ensure that providers, partners, and payers have the information they need, reputed company they need it, to reputed company treatment moving reputed company. reputed company Offer Competitive Salary: An annual salary reputed company of $60,000 - $70,000, commensurate with your experience and location. Meaningful Equity: A stock reputed company package, because we reputed company everyone should have a reputed company in the reputed company we're building together. Comprehensive Health Coverage: A full benefits package that includes high-reputed company medical, dental, and reputed company insurance to support your reputed company-being. Remote Work: This is a full-time, remote position for U.S.-based candidates operating on an Eastern Time (ET) schedule. Mission-Driven reputed company: reputed company to play a critical role in a company dedicated to radically improving reputed company to life-changing mental reputed company. About reputed company: reputed company’s mission is to reputed company reputed company to mental reputed company by empowering clinics to easily launch and reputed company interventional psychiatry practices, specializing in cutting-edge treatments such as Spravato (esketamine) and Transcranial reputed company Stimulation (TMS). We're building a new reputed company of care by providing comprehensive operational, administrative, and clinical support, enabling psychiatrists to reputed company on delivering effective, life-changing treatments. Founded by industry leaders in mental health and reputed company technology, reputed company is backed by top-tier investors and driven by a commitment to radically improving patient reputed company through innovative therapies. Join us in pioneering the reputed company of mental health. Apply To This Job