Assists providers with real-time documentation assistance for clinicians to free the clinician from enough data entry so that he/she can focus on other aspects of quality patient care; accompanies provider in room and documents clinical note, laboratory results, prescription refills, procedures, billing information and any other documentation as directed by the provider.
EDUCATION and/or EXPERIENCE
ESSENTIAL JOB FUNCTIONS
1. Accompanies provider in room during patient visit.
2. Scribes document in EPIC to include: history of present illness, review of systems, physical exam findings, diagnostic assessment and plan of care.
3. Documents results of laboratory and radiographic studies as discussed by provider.
4. Refills any patient prescriptions as directed by the provider.
5. Enters orders for procedures or labs as directed by the provider.
6. Enters billing information as determined by the type of office visit.
7. Coordinates multiple projects and patients and solve problems under pressure.
8. Communicates and interacts professionally with others.
9. Treats all information and data utilized in the scope of the scribe position with complete confidentiality and security in compliance with governing HIPAA regulations.
10. Maintains accurate patient records.
11. Responsible for following OSHA and departmental regulations.
12. Regularly interacts with physicians and other departments in order to identify and resolve problems.
13. Maintains patient, employee and clinic confidentiality.