Described by The New York Times as "modern and thorny," music of Sarana Chou is known for its distinct expressiveness and intense musical language. The Birmingham News praised her as "a composer with a convincing point of view and the facility to get her ideas across." Sarana Chou has received numerous composition awards including first prize at ASCAP Morton Gould Young Composer Awards, the Ellen Taaffe Zwilich Prize from International Alliance for Women in Music, the International Call for Duet at Shanghai Conservatory of Music in China, USA Florida Chapter of the International Society of Contemporary Music (ISCM) competition, and Wright State University Trombone Festival Composition Contest.

Sarana Chou's music has been widely performed, most notably at Lincoln Center's Alice Tully Hall, Carnegie Hall's Weill Recital Hall in New York City, Taiwan National Recital Hall in Taipei, and Akademie der Künste in Berlin, Germany; Her music has also been featured in music festivals such as The Banff Summer Arts Festival in Canada, New Music Miami Festival, and June In Buffalo Festival. She has composed for such artists as Boston Brass, Pacifica Quartet, flutist Demarre McGill of MET Orchestra, pianist Jenny Lin, and ProArt Bassoon Quartet. Her concerto for piano and orchestra Spotlight On was performed in the Composer's Forum of Buffalo Philharmonic Orchestra with conductor Robert Franz.

Sarana Chou moved to the United States in 1998 from her native Taiwan, to pursue composition studies under Samuel Adler, Shulamit Ran, Robert Morris, and David Liptak at The Juilliard School (B.M. '02), the University of Chicago (M.A. '04), and Eastman School of Music (D.M.A. '09), respectively. From 2008-2013, she was Assistant Professor and Director of Graduate Studies in Music at Samford University in Birmingham, Alabama. She currently teaches composition and music theory at West Virginia University School of Music, and also serves as an official rater/reader of the AP Music Theory Exams by ETS.