Purchase Referred Care Specialist at Redding Rancheria

***This position is open through Friday, September 5th, 2025.***

The Redding Rancheria is seeking a Purchase Referred Care Specialist. The preferred schedule for this position will be required to work 40-hours per week, specific days and times discussed upon employment offer.

JOB SUMMARY:

Monitor referral and emergency room purchase orders pertaining to medical and dental services being provided under contract with providers outside the Redding Rancheria Tribal Health Center.  Ensure that services provided are delivered in accordance with established policies and procedures and contract.

REQUIREMENTS/MINIMUM QUALIFICATIONS:

1. College course work in Accounting or related field or 3 years equivalent work experience.
2. Demonstrated work experience in accounting or related area.
3. Requires attention to detail involved in auditing financial statements.
4. Must pass pre-employment drug screening.
5. Indian preference.

ESSENTIAL JOB DUTIES:

1. Audit emergency room visits for accuracy of 72-hour notice, eligibility for treatment and payments by alternate resources. An alternate resource is a payer that is fully or partially responsible for payment. Purchase Referred Care (PCR) is a payer of last resort. The Specialist must make every effort to obtain timely payment from all alternate resources before obligating funds from Purchase Referred Specialist.
2. Inform the Registration/Alternate Resources Department when patients are referred to the Clinic without any insurance.
3. Assist with payments to outside providers for services rendered for patients who have been determined to be eligible for PCR services. No payments may be made of funds obligated unless the PCR Committee has determined that the patient is eligible for services. Payments must be made on a timely basis since failure to do so jeopardizes critically important relationships with outside providers and delay in payments may result in loss of discounts to the Clinic. Payments consist of purchase orders made payable to outside providers.
4. Provide assistance to outside providers as needed to track purchase orders, payments and eligibility for payment to those providers.
5. Interact with patients and their families to ensure timely, accurate and complete receipt of bills, invoices, medical records and other documentation related to the care of patients. The Specialist must be familiar with and observe the guidelines of the Health Insurance Portability and Accountability Act (HIPAA) as they relate to Protected Health Information. The Specialist must follow the HIPAA guidelines when releasing Protected Health Information to anyone.
6. For audit purposes, ensure that proper records are maintained. Records include verification of status as a California Indian, medical records, invoices, statements, explanation of benefit (EOB) forms, and any other documentation necessary to a complete understanding of why payment was rendered of denied. These records will be kept as a scanned document in Doc star.
7. Maintain cost containment procedures as outlined in Clinic or Tribal policies or as directed by the Health Operations Director. 
8. Obligating funds in accordance with referral purchase orders that have been approved by the PRC Committee and preparing those referral purchase orders as they are approved by the PRC  Committee.   The Specialist must verify that each referral purchase order contains the appropriate signatures and authorizations from the PRC Committee.
9. This position has no supervisory responsibilities.
10. Maintain a good working relationship within the Clinic and Tribal Administration offices.  The Specialist will make every effort to accommodate the needs of other departments as they request assistance from PRC.
11. Will assist in the negotiation of favorable reimbursement rates from PRC providers and attempt to maximize discounts available to the Clinic from the PRC providers.

A completed Redding Rancheria job application must be submitted in order to be considered for employment. You can fill out an application online at www.reddingrancheria-nsn.gov, please fax (530-242-4563) or email ([email protected]).

All certifications, credentials/licenses, education verification /degrees and/or transcripts, and Indian verification are required to process your application.

Indian preference applies, but we welcome all applicants who wish to apply for this position. Certification of Native American heritage needs to be attached to the job application.

Any offer of employment is conditioned upon the successful completion of a pre-employment drug screen and criminal background screening clearance.  All employees are required to submit to a Tuberculosis test (TB) test after they are hired in addition to being tested annually.

Additional Information:

In addition, Redding Rancheria offers an excellent benefit package containing Medical, Dental, Vision, Life Insurance and Short/Long Term disability, paid holidays, vacation and sick leave as well as a generous 401(k) retirement plan.

Redding Rancheria is a federally recognized Tribe with Pit River, Wintu and Yana people where pride in Tribal culture, history and identity is evident internally and in the larger community. Redding Rancheria is a leader in the constructive development of its people, the larger Indian community and the Redding region.

E-Verify Statement

Redding Rancheria participates in the Electronic Employment Verification Program. Visit the E-Verify URL below for more information.

https://www.e-verify.gov/employees

For further information, please contact Human Resources Dept. at (530) 225-8979.