Kiara Nash
Mesa,AZ
Summary
Experienced healthcare operations professional with 15+ years of progressive leadership in medical and specialty pharmacy claims. Proven expertise in prior authorization, billing, enrollment, and payer navigation across commercial and government insurance systems. Adept at leading teams, resolving complex claims issues, and streamlining workflows to ensure timely reimbursement and compliance. Known for precision, advocacy, and cross-functional collaboration in high-volume environments.
Overview
15
15
years of professional experience
Work History
Healthcare Operations Specialist
Kabafusion
04.2022 - Current
- - Lead intake and referral processing for acute therapies (IVIG, TPN, IV antibiotics, ect.) across diverse payer systems
- - Collaborate with clinical, financial, and administrative teams to ensure seamless patient onboarding and care coordination
- - Oversee insurance verification, authorization workflows, and financial counseling for new patients
- - Champion process improvements that reduce delays and elevate patient satisfaction
Concierge Services Team Lead
Oscar Health
11.2019 - 04.2022
- - Directed a high-performing member services team focused on satisfaction, care quality, and operational excellence
- - Spearheaded hiring, training, and performance coaching for Concierge staff
- - Led strategic huddles and feedback loops to align team culture with organizational values
- - Implemented data-driven coaching plans and quality assurance protocols to improve service delivery
Intake Lead
Vasco Infusion
11.2015 - 09.2018
- - Managed verification and authorization operations for home infusion therapy
- - Trained and mentored intake staff, developed SOPs, and led audits to ensure compliance and accuracy
- - Conducted benefit investigations and secured documentation for prior authorizations
- - Served as escalation point for complex cases and integrated workflows across departments
Billing & Enrollment Specialist
UHC Military & Veterans
02.2013 - 08.2015
- - Oversaw TRICARE enrollment and billing operations for military families across multiple regions
- - Educated beneficiaries on coverage options and processed QLE-related updates
- - Resolved billing discrepancies and supported claims processing for providers and patients
- - Collaborated with military hospitals, civilian providers, and third-party contractors to streamline service
Senior Pharmacy Services Representative
Cigna
06.2010 - 01.2013
- - Led pharmacy operations including prescription entry, claims resolution, and workflow coordination
- - Trained new technicians and served as SME for pharmacy procedures and SOPs
- - Interfaced with providers and patients to ensure accurate medication coverage and dispensing
- - Supported team development and problem-solving in a high-volume environment
Education
High School - General Studies
Maryvale High School
12.2000
Skills
- Commercial and Government Payers
- Appeals and Grievances
- ICD-10
- Specialty Infusion Billing
- Claims Resolution
- Team Leadership
- Benefit Investigations
- EOB Interpretation
- Compliance & Documentation
- Case Management
- Workflow Optimization
- Patient Advocacy
- Prior Authorization
- Cross-Functional Collaboration
- Medical Billing & Coding
- Insurance Verification
- Quality Assurance
- Epic
- CPR
- One Note
- Microsoft Excel
- Sharepoint
Work Preference
Work Type
Full TimePart TimeLocation Preference
RemoteImportant To Me
Work-life balanceCareer advancementCompany CultureWork from home optionHealthcare benefitsWork Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
swipe to browse
Timeline
Healthcare Operations Specialist
Kabafusion
04.2022 - Current
Concierge Services Team Lead
Oscar Health
11.2019 - 04.2022
Intake Lead
Vasco Infusion
11.2015 - 09.2018
Billing & Enrollment Specialist
UHC Military & Veterans
02.2013 - 08.2015
Senior Pharmacy Services Representative
Cigna
06.2010 - 01.2013
High School - General Studies
Maryvale High School