Health Information Management Scribe -- Transcription -- Document Center Building

---

Job description

Job Summary

The scribe is responsible to capture accurate and detailed documentation of patient encounters in the electronic health record (EHR) or by handwritten record. Scribes are not permitted to make independent decisions or translations while entering information into the medical record.

Responsibilities

• Assist the physician in navigating the EHR. • Respond to various messages as directed by the physician. • Locate information for review (i.e., previous notes, reports, test results, lab results). • Entering information into the medical record as directed by the physician (click or type). • Researching information as requested by the physician. • Recording handwritten information using approved downtime procedures when necessary. • Assist the physician in ensuring all critical documentation is available and recording for accurate coding. • Set up Normals and templates for clinicians. • Assist new clinicians in efficient use of Dragon and Cerner. • Act as liaison with Desktop Support to troubleshoot any issues. • Order tests, blood work, etc. or other services for patient as direction by physician. (Follow up as physician directs during patient visit). • Other duties as assigned. • Support nursing with their daily clerical duties.

Knowledge, Skills & Abilities

1. Maintain and document all applicable required education. 2. Demonstrate positive customer service and co-worker relations. 3. Comply with the company's attendance policy. 4. Participate in the continuous, quality improvement activities of the department and institution. 5. Perform work in a cost effective manner. 6. Perform work in accordance with all departmental pay practices and scheduling policies, including but not limited to, overtime, various shift work, and on-call situations. 7. Perform work in alignment with the overall mission and strategic plan of the organization. 8. Follow organizational and departmental policies and procedures, as applicable. 9. Perform related duties as assigned.

Education

• High School Diploma or GED (Required) Experience: 2 yrs experience in medical office, clinical, or hospital setting. Medical transcription experience is preferred. Substitutions: Formalized training in Medical Transcription, Medical Terminology, and/or Physiology may be substituted for 2 yrs experience

Credentials

• No Certification, Competency or License Required

Work Schedule: Days

Status: Full Time Regular

Location: Document Center Building

Location of Job: US:WV:Charleston