Medical Scribe for South Texas Colorectal Center

Tenet Healthcare; San Antonio (TX); On-site; USD 30,000 - 50,000; Full time

Job summary

A leading healthcare provider is looking for a scribe to support physicians by documenting patient encounters in real-time. The ideal candidate will have experience in a medical office setting, relevant certifications, and a strong understanding of compliance standards. This clerical role is essential to maintaining accurate medical records and facilitating patient care processes.

Qualifications

• Completion of a medical office assistant or Medical Assisting program is required.
• CMA and CPR certifications are necessary.
• Minimum of 2 years' experience in a physician practice setting.

Responsibilities

• Chart patient encounters in real-time during visits.
• Manage and organize medical documents in the EMR system.
• Support compliance with HIPAA and corporate policies.

Skills

HIPAA Compliance

Office Functions

Documentation Accuracy

Education

High school diploma/GED

Medical office assistant or Medical Assisting program

Tools

Electronic Health Record

Job description

The specific tasks of the scribe depend on the physician/provider. The core responsibility is to follow the provider during the assigned period and chart patient encounters in real-time using the Electronic Health Record, templates, or paper records. The scribe must record interactions as dictated by the physician/provider and should not add personal observations or impressions. This role is clerical and does not involve direct patient care.

Qualifications

Education: High school diploma/GED required, with completion of a medical office assistant or Medical Assisting program.

Certification: CMA and CPR certifications. Licensed Practical Nurses, Registered Nurses, or other clinical professionals may serve as scribes if they meet or exceed minimal credentialing requirements and adhere to all policies and provisions.

Experience: Minimum of 2 years working in a physician practice setting.

Responsibilities

• Support the mission, purpose, philosophy, objectives, policies, and procedures of Tenet Physician Resources.
• Follow HIPAA Compliance Plan and Privacy Standards.
• Support the Corporate Compliance Program by understanding compliance responsibilities, adhering to laws and policies, and reporting issues timely.
• Chart patient encounters in real-time during visits.
• Review documentation for accuracy.
• Manage and organize medical documents in the EMR system.
• Generate referral letters for physicians.
• Assist physicians with e-Scribing.
• Perform other office functions as needed.