Job Summary:

The Medical Scribe/Team MA is an integral part of the patient care team, working side by side with our clinicians as they care for patients. They are responsible for facilitating accurate and timely documentation. The Medical Scribe/Team MA will build and sustain positive, productive relationships that support the physician’s efficiency in multiple settings including hospital, ASC, and clinic, and perform basic clinical duties, routine patient care, and standard clerical responsibilities.

Essential Duties and Responsibilities:

• Assist the provider in navigating the EMR and make entries into the health record as authorized by the provider and within scope of practice.
• Create templates, letters, smart phrases, narrative lists, etc to increase efficiency of documentation in the medical record.
• Locate pertinent patient information and prior medical records to obtain past medical history, including prior labs, imaging, etc. needed to help provider prepare for patient consults and procedures.
• Chart in real time while provider assesses and examines patient.
• Appropriately document procedures and treatments performed by Physician and create orders for provider approval at their direction.
• Transcribe all ancillary test results, including any lab and imaging tests into registries and other EMR flowsheets or chart notes.
• Record physician dictated diagnosis, prescriptions and instructions for patient care/follow up.
• Respond to patient messages under the direction of the provider.
• Support provider team with patient phone calls, pathology letters, and answer patient questions regarding prep instructions, etc.
• Perform chart prep, review patient intake and validate reason for visit
• Greet and room patients when working in outreach, assist with patient vital signs, medical history review, repositioning, pre and post-operative instructions, and assist in patient discharge, entering pertinent information into an EMR.
• Communicate post operative orders with clinic teams as directed by provider and assist provider with overall day-to-day communication with internal teams, families, etc. as needed/necessary.
• Support and adhere to established workflows to ensure all necessary documentation is immediately available for proper medical coding and billing.
• Perform administrative or clerical duties as assigned, including filing, reception, scheduling, data entry, and/or patient registration.
• Other duties as assigned.

Education and Experience:

• High school diploma or equivalent
• BLS certification required
• Experience with GI or Pain Management preferred
• Proficiency in MS Excel
• Mastery of complex EMRs (EPIC, gGastro, etc)
• Knowledge of GCP, federal, state, and local regulations, including HIPAA policies and procedures.