Medical Scribe

30+ days ago

Job Description

Qualifications:

Bachelor's Degree or pertinent college level courses and three years of administrative/office management experience
Must be proficient with EPIC EMR and comply with specific standards that apply to the legal and ethical requirements for preparing medical documents while being HIPAA compliant
Language Skills- Medical scribe must be proficient in EPIC EMR, typing, spelling, punctuation, grammar, and oral communication
Excellent English composition skills required to generate professional, polished writing at a high rate of production
Computer Skills- To perform this job successfully, an individual should be able to learn and use all functions of the EPIC EMR system
Must be able to type quickly and accurately; must comply with HIPAA confidentiality standards when accessing or communicating patient information
Must successfully pass pre-employment health clearance if working onsite

Responsibilities:

Maintain and perform administrative charting of clinical services provided to patients by a healthcare professional within the Department
Thorough and accurate documentation of all encounter visits and procedures as they are being performed by the physician, including but not limited to: Patient medical history and physical exam
Procedures and treatments performed by healthcare professionals, including nurses and physician assistants
Accurate and thoroughly scribed Physician-dictated diagnoses, medications and instructions for patient or family members
Under direction of the provider, prepare accurate referral letters as requested by the provider.
Ensure that all clinical data, lab or other test results, the interpretation of the results by the physician are recorded accurately in the electronic medical record and will always document that the note was scribed on behalf of Doctor
Attend patient selection and other multidisciplinary patient care committee meetings as assigned
Consult with the RN Coordinator and/or Physician Committee Chair to ensure accuracy and adequacy of documentation

Location

Syracuse, New York

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