T.H.E. HEALTH AND WELLNESS CENTERS
JOB DESCRIPTION
POSITION: Medical Scribe
DEPARTMENT: Medical Unit
STATUS: Full-Time, Non-Exempt
POSITION SUMMARY: Under the direct supervision of the Medical Unit Manager,
the Medical Scribe performs all clerical and information
technology functions for a physician in a specialty clinic
setting, including primary responsibility for the operation
of electronic health records and dictation.
Essential Duties and Responsibilities:
1. Accompany physician into the patient examination room in order to transcribe a
history and physical exam, and document accurately the physician's encounter with
the patient and others present
2. Greets all patients in a professional and friendly manner.
3. Perform documentation in EHR software for physicians for all patients
4. Handles confidential material while protecting its strict confidentiality under HIPPA
guidelines
5. Speak clearly and distinctly using appropriate vocabulary and grammar to obtain and
convey information while
6. Transcribe patient orders including laboratory tests, radiology tests, medications, etc
7. Attends and participates in meetings as required.
8. Document any procedures performed by the physician
9. List all proper diagnoses and symptoms as well as follow up instructions and
prescriptions as dictated by the physician.
10. Add Chief Complaints to ECW
11. Other duties as assigned.
Education and Qualifications
• High School Diploma or equivalent
• Ability to work with people of diverse cultural, educational, social, and economic
backgrounds.
• Detailed knowledge of medical terminology and the ability to distinguish different
exams and medical diagnoses
• Ability to work independently and a self-starter with minimal supervision
• Excellent oral and written communication skills
• Excellent organizational skills
• Computer proficiency
• They must have exceptional organizational skills with focus on tracking patient care
and improving patient flow.
• Experience utilizing an Electronic Medical Records (EMR) system is highly desirable
• Bilingual preferred
• Obtain CPR within two weeks of hire