Urology Clinic Documentation Specialist (Medical Scribe)

DHR Health; Edinburg (TX); On-site; USD 38,000 - 52,000; Full time

Job summary

DHR Health in Edinburg, Texas seeks a Documentation Specialist in the Urology Clinic to assist physicians with complete chart documentation. The role involves accompanying physicians on rounds and documenting observations in EMR systems in a fast-paced clinical setting.

Ideal candidates have medical terminology knowledge, strong written/verbal skills, and experience with Microsoft Office. High school diploma or GED and CNA/MA certification are desirable attributes for consideration.

Qualifications

• High School graduate or equivalency is preferred.
• Medical Terminology required.
• CNA or Medical Assistant certification from an accredited school preferred.
• Computer skills required with knowledge of Microsoft Office suite.
• Good written and verbal communication skills required.

Responsibilities

• Promotes the facility mission, vision and values by effectively communicating them to others.
• 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.

Skills

Medical Terminology

Written & Verbal Communication

Computer Skills

Education

High School Diploma or GED

CNA or Medical Assistant certification

Tools

Microsoft Office

Job description

DHR Health in Edinburg, Texas seeks a Documentation Specialist in the Urology Clinic to assist physicians with complete chart documentation. The role involves accompanying physicians on rounds and documenting observations in EMR systems in a fast-paced clinical setting.

Ideal candidates have medical terminology knowledge, strong written/verbal skills, and experience with Microsoft Office. High school diploma or GED and CNA/MA certification are desirable attributes for consideration.