Open To Work
Kiara Nash
Houston,TX
Work Preference
Summary
Healthcare operations specialist with extensive experience in prior authorization processes and team leadership. Proven ability to manage workflows, resolve billing discrepancies, and ensure accurate documentation in high-pressure environments. Dedicated to enhancing patient experiences through effective communication and problem-solving skills.
Overview
16
16
years of professional experience
Work History
Authorization Specialist
Kabafusion
04.2022 - Current
- Process prior authorizations for IVIG, specialty medications, and infusion therapies with strong attention to clinical detail.
- Research formulary rules, benefit requirements, medication criteria, and plan-specific policies to resolve authorization questions and benefit issues.
- Gathered and verified member, provider, prescriber, pharmacy, diagnosis, and clinical support information to facilitate pharmacist or clinician review.
- Identified and addressed missing or incomplete information through follow-up via outbound calls, secure messages, or routing to appropriate team.
- Prioritize cases based on urgency to meet turnaround times for standard, expedited, urgent, and client-specific requests.
- Maintain productivity, quality, schedule adherence, and documentation standards in a fast-paced, metric-driven environment.
- Resolved issues with professionalism and escalated cases needing clinical review or leadership guidance.
Patient Services Lead
Oscar Health
11.2019 - 04.2022
- Led and coached Concierge team members to deliver exceptional member experiences, strengthening communication, problem-solving, and confidence.
- Served as the central communicator for the team - running huddles, sharing updates, clarifying priorities, and aligning daily work with company strategy.
- Partnered with Nurse Leads and clinical teams to refine workflows, improve operations, and remove barriers that slowed case processing.
- Oversaw hiring, onboarding, and scheduling while reviewing team interactions to ensure consistent service standards across all member experiences.
- Verified member, provider, prescriber, pharmacy, medication, diagnosis, and clinical documentation to prepare cases for pharmacist consultation or clinical review.
- Identified missing information and completed follow-up through outbound calls or routing to the correct team, pharmacist, or clinician.
- Prioritized work to meet turnaround times for standard, expedited, urgent, and client-specific requests.
- Maintained performance in a metric-driven environment, consistently meeting expectations for productivity, quality, and documentation accuracy.
- Resolved member issues promptly and escalated cases requiring clinical review or leadership support to enhance overall member satisfaction.
Intake Lead
Vasco Infusion
01.2017 - 09.2019
- Managed intake operations for infusion patients, coordinating referrals, benefits verification, and authorization preparation.
- Trained and supported intake staff to enhance accuracy, communication, and workflow consistency.
- Collaborated with clinical and billing leaders to streamline processes and reduce delays in patient onboarding.
- Guided patients in understanding benefits and next steps, ensuring clear communication and advocacy.
- Coordinated with providers and payers to resolve discrepancies in eligibility, documentation, and benefits.
- Maintained accurate intake records and upheld compliance across all patient interactions.
- Supported escalated cases and complex referrals with timely communication and follow-through.
Enrollment Specialist
United Healthcare (TRICARE)
02.2013 - 06.2016
- Guided military members and families through TRICARE enrollment, plan changes, and eligibility updates to ensure comprehensive coverage.
- Clarified plan benefits and coverage options, enabling members to effectively utilize available resources.
- Resolved billing inquiries and ensured accurate submission of claims and payments.
- Updated member records across multiple systems while maintaining strict privacy and compliance standards.
- Achieved call quality, production, and attendance metrics, contributing to overall team performance.
Senior Service Associate
Cigna Pharmacy
06.2010 - 01.2013
- Reviewed and adjudicated medical and pharmacy claims with accuracy and compliance.
- Guided patients and providers through benefit, eligibility, billing, and authorization inquiries to ensure clarity and compliance.
- Educated patients on benefits and facilitated navigation of care pathways to enhance their healthcare experience.
- Investigated and resolved billing discrepancies and claims-related issues to restore accuracy and support timely processing.
- Collaborated with pharmacists, providers, and internal teams to ensure smooth claim processing.
- Delivered training on benefit workflows and supported escalations during live calls.
Education
High School Diploma (GED) -
Maryvale High School
Phoenix, AZPhoenix, AZ
Skills
- Claims processing
- Infusion coordination
- Clinical review
- Member and provider support
- Data management
- EMR and multi-system navigation
- HIPAA compliance
- ICD-10 and CPT familiarity
- Grievance management
- Team leadership
- Patient communication
Accomplishments
- Increased prior authorization success by 40%
- Reduced claim denials by 30%
- Resolved 95% of escalated issues within 24 hours
- Improved workflow efficiency by 25% through coaching and process redesign
Timeline
Authorization Specialist
Kabafusion
04.2022 - Current
Patient Services Lead
Oscar Health
11.2019 - 04.2022
Intake Lead
Vasco Infusion
01.2017 - 09.2019
Enrollment Specialist
United Healthcare (TRICARE)
02.2013 - 06.2016
Senior Service Associate
Cigna Pharmacy
06.2010 - 01.2013
High School Diploma (GED) -
Maryvale High School