Clinical Documentation Scribe - Hospital Data & Charting

DHR Health; McAllen (TX); In loco; USD 42.000 - 62.000; Tempo pieno

Descrizione del lavoro

DHR Health is seeking a Clinical Documentation Specialist Scribe to support physicians in accurately documenting patient charts during visits and rounds. The role emphasizes thorough data capture in EMR systems and collaboration with clinical teams.

The ideal candidate will have medical terminology knowledge, bilingual English/Spanish, and strong communication skills to ensure compliant, timely documentation and patient care continuity. This is a full-time days shift at Ent Institute.

Competenze

• High School graduate or equivalency is preferred.
• Medical Terminology required.
• Computer skills required with knowledge of Microsoft Office suite.
• Good written and verbal communication skills required.
• Bilingual – English/Spanish.
• Position requires travel, valid driver’s license and vehicle insurance are required

Mansioni

• Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
• Keep track of laboratory tests, medications, and radiology tests ordered by the physician
• Gather data for physician review (i.e., laboratory results, faxed radiology reports, medical records)
• Coordinate communication between physicians and staff, make and answer telephone calls
• Document any consultations the physician makes to a patient’s personal doctor, family members, on-call physician, or other members of the medical community
• Take vital signs and room patients as needed
• Accompany provider to hospital to document consults or hospital rounds as needed
• Provide patients with updates about waits and delays
• Document all procedures done by the physician, as dictated by the physician
• Responsible for documenting all diagnoses, treatment plans, prescriptions, and discharge/follow-up information for each patient
• Other duties as assigned

Conoscenze

Medical terminology

Bilingual English/Spanish

Communication skills

Microsoft Office

Formazione

High School diploma or equivalent

Strumenti

Microsoft Office

EMR system

Descrizione del lavoro

DHR Health is seeking a Clinical Documentation Specialist Scribe to support physicians in accurately documenting patient charts during visits and rounds. The role emphasizes thorough data capture in EMR systems and collaboration with clinical teams.

The ideal candidate will have medical terminology knowledge, bilingual English/Spanish, and strong communication skills to ensure compliant, timely documentation and patient care continuity. This is a full-time days shift at Ent Institute.