What are the responsibilities and job description for the Medical Scribe position at Lakeshore Ear, Nose, Throat - Rochester & Sterling...?
Company Overview
Lakeshore Ear, Nose, Throat Center is dedicated to providing exceptional healthcare services in the field of otolaryngology. Our mission is to enhance the quality of life for our patients through comprehensive diagnosis and treatment of ear, nose, and throat conditions.
Summary
An individual who is present during the provider’s performance of a clinical service and documents on behalf of the Licensed Independent Provider (LIP). This individual will document the providers observations and instructions during the patient encounter into the electronic medical records (EMR) system.
Essential Job Functions
Duties include, but are not limited to:
- Document patient encounters in real-time, ensuring accuracy and adherence to healthcare standards.
- Function under the direct presence of a LIP and only document information cited by the LIP.
- Be present during the LIP’s performance of clinical service, and document on behalf of the LIP everything said during the course of the service.
- Assist the LIP by locating test results, supporting workflow, and entering documentation.
- Assist healthcare providers with clinical documentation, including history, physical exams, and treatment plans.
- Enter orders at the direction of the LIP for him/her to approve and must always repeat the order back to provider.
- Enter information into EMR systems such as chief complaint, medication history, or any component of the history & physical, consultation, office note, progress note or treatment note.
- Maintain detailed and organized electronic medical records (EMR) to support patient care.
- Communicate effectively with clinical staff and patients to clarify information and ensure comprehensive documentation.
- Support the healthcare team in maintaining compliance with regulatory requirements and best practices.
- Other duties as assigned.
Education / Experience / Environment
Education:
- High school diploma or GED equivalent; a degree in a related field is preferred.
- Certification or coursework in medical scribing or other equivalent training.
Experience:
- Previous experience as a medical scribe or similar position a healthcare setting.
- Proficient in medical terminology and healthcare documentation practices.
- Previous experience using electronic medical records (EMR) or other relevant software.
Licensure / Certification / Registration:
- Certification or coursework in medical scribing or related fields preferred.
Skills:
- Excellent verbal and written communication skills.
- Friendly and personable.
- Strong computer skills including Microsoft Office, EMR systems, and dictation software.
- Ability to use email and electronic calendars.
- Critical thinking skills and decisive judgment.
- Ability to work in a fast-paced environment.
- Familiarity with telehealth platforms and healthcare information systems.
- Knowledge of HIPAA regulations and patient confidentiality standards.
- Strong attention to detail and a commitment to accuracy in documentation.
- Ability to prioritize tasks and manage time effectively in a dynamic environment.
- Demonstrated professionalism and a patient-centered approach.
- Strong interpersonal skills and the ability to collaborate with diverse healthcare teams.
Personal Protective Equipment:
- Follows Standard Precautions using personal protective equipment as required.
Physical Demands:
- Sit and stand for extended periods of time.
- Talk or hear for extended periods of time.
- Dexterity of hands and fingers in order to operate a computer keyboard.
- Lift and/or move up to 25 pounds.
- Close vision, distance vision, peripheral vision, depth perception and ability to adjust focus.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily in the designated work environment. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Job Type: Full-time
Pay: From $16.00 per hour
Expected hours: 40 per week
Benefits:
- 401(k)
- Dental insurance
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Medical Specialty:
- Otolaryngology
Schedule:
- 8 hour shift
- Monday to Friday
Education:
- High school or equivalent (Preferred)
Experience:
- medical scribe: 1 year (Preferred)
Work Location: In person
Salary : $16