SCRIBE Job Description
SCRIBE
provides a crash course in medicine including terminology, disease processes, procedures, medications, medical decision making, and more.
SCRIBE Duties & Responsibilities
To write an effective SCRIBE job description, begin by listing detailed duties, responsibilities and expectations. We have included SCRIBE job description templates that you can modify and use.
Sample responsibilities for this position include:
When applicable, discusses follow-up care with the patient prior to the completion of the examination
Evaluates the condition of the examination room to ensure adequate supplies are in stock
Look up pertinent past medical records
Enter the patient's discharge/after visit summary plan and any prescriptions
Generate referral letters for physicians, manage and sort medical documents within the electronic medical record system
CIM/Scribe New Hire Training
Transcribe patient orders including labs, radiology, other diagnostic tests, medications
Alert medical provider when chart is incomplete, or if medical record contains errors or inconsistencies documentation in order to reduce errors
Dictation/faxing/phone calls and clerical tasks
The scribe under the direction of the physician transcribes patient orders, including laboratory tests, radiology tests, medications
SCRIBE Qualifications
Qualifications for a job description may include education, certification, and experience.
Licensing or Certifications for SCRIBE
List any licenses or certifications required by the position: CPR, CMA, CMT, CNA, BLS, CIM, MA, EMT
Education for SCRIBE
Typically a job would require a certain level of education.
Employers hiring for the SCRIBE job most commonly would prefer for their future employee to have a relevant degree such as High School and Bachelor's Degree in Medical Terminology, Education, Medical, Healthcare, Physiology, Anatomy, Associates, Graduate, Biology, Nursing
Skills for SCRIBE
Desired skills for SCRIBE include:
Medical terminology
Billing codes to help increase a provider’s charting efficiency
Medical terminology and accepted abbreviations
Anatomy
Diagnostic and treatment room procedures
Examination
Medical terminology for appropriate medical specialties
Physiology and pharmacology
California Scope of Practice for Medical Assistants
Scheduling practices/referrals for physician offices
Desired experience for SCRIBE includes:
Successfully demonstrated proficiency in the CIM/Scribe role in an Emergency Department or in a hospital setting
Successfully demonstrated computer skills, proficiency in PowerPoint, and ability to learn new technology
Successfully demonstrated time management and organizational skills Strong creative thinking skills
Ability to use a variety of learning/training concepts and principles
The scribe completes the patient’s chart by transcribing results of any labs, x-rays, or other evaluations
The scribe lists all proper diagnosis any discharge/follow up instructions and prescriptions as directed by the physician
SCRIBE Examples
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SCRIBE Job Description
Job Description Example
Our company is searching for experienced candidates for the position of SCRIBE. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for SCRIBE
- Retrieve and display current and past EKGs and imaging films
- Take dictation using either shorthand or a stenotype machine, or using headsets and transcribing machines
- Accompanies physician into exam room with patient, entering information in electronic medical record regarding patient symptoms and condition as physician interviews patient
- Transcribes medical decision-making in real time under direction of physician, creating polished patient encounter notes that will also be sent to referring MDs
- Input real-time encounter information into a template electronic health record using a wireless device
- Edit all completed health records for accuracy regardless of whether clinicians dictated directly into the EHR using voice recognition software or the information is keyed in using templates or a combination
- Obtain physician authentication and authorship using approved methods such as electronic signature
- Print out any copies approved for distribution to the patient or a third party following HIPAA rules for verifying the release of information is done in a legal manner
- Check schedule to ensure every patient examined has that day’s reports in the patient’s EHR
- Check patient charge sheets to ensure charges match procedure performed
Qualifications for SCRIBE
- Final exam
- Clinical training
- Initial competency assessment
- Facility-specific training
- Specialized (1 year of training beyond high school)
- Ensure record does not have any missing information
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SCRIBE Job Description
Job Description Example
Our innovative and growing company is looking for a SCRIBE. To join our growing team, please review the list of responsibilities and qualifications.
Responsibilities for SCRIBE
- Dictation occurs in an exam room with patient, and provider, and also in an office setting with the provider only
- Incumbent works closely with a team of clinic caregivers, including physicians and mid -level providers to ensure the delivery of high quality patient care
- Position reports directly to the Site Supervisor or Practice Manager
- Work closely with physician and/or advanced level providers and clinical staff to ensure the highest level of patient care
- Will function at all times under a physician or advanced practitioners direct supervision
- Will abide by all applicable Steward policies and procedures including, but not limited to, safety matters, HIPAA-compliance and patient/computer confidentiality
- Research and source qualified candidates in target markets
- Screen candidate resumes and applications submitted through MModal’s ATS online tool, internal referrals, partner organizations and other sources for qualifications match such as availability, compensation, and other prescribed client project requirements
- Interview candidates to confirm candidate match with requirements
- Managing relationships with hiring managers and candidates
Qualifications for SCRIBE
- Prior teaching experience preferred BLS training, MCAT prep course, science tutor
- Biology coursework at the undergraduate level or above required
- A minimum of 1 year of work experience in the healthcare field may be considered in lieu of the education requirement
- Experience in a direct patient care environment preferred EMT, scribe, clinical technician in a hospital, medical assistant in a doctor’s office
- Health care student
- Some college, medical or nursing background or someone that has worked medical/pharmacy and understands the medical knowledge would be ideal
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SCRIBE Job Description
Job Description Example
Our growing company is hiring for a SCRIBE. We appreciate you taking the time to review the list of qualifications and to apply for the position. If you don’t fill all of the qualifications, you may still be considered depending on your level of experience.
Responsibilities for SCRIBE
- For duties 1-3, information is obtained directly from provider
- Maintains training program for scribe program
- Recruits, interviews, and trains new scribes while actively preparing and updating training materials
- Develops and reviews scribe job descriptions as needed
- Ensures that all scribes develop knowledge and understanding of electronic medical record and coding guidelines through review of scribes’ notes and standardized training
- Consistently checks in with scribes, clinicians, and their site managers to review workflow processes and address any concerns
- Communicates with scribes regarding updates in policies and workflows and provides feedback on work performance
- Runs reports and tracks progress of the Scribe Pilot and/or program, including clinician productivity reports
- Collaborates with administrators to provide input on progress of the Scribe program, identify limitations, and offer ideas for solutions
- Coordinates scheduling scribes at primary care clinics and communicates regularly with site contacts
Qualifications for SCRIBE
- Familiar with adobe
- Organized and a great note taker
- Medical Assistant Highly Preferred
- Previous experience working in a medical office setting preferred
- No previous skills required, however education or experience in health care preferred
- Experience in medical field or currently enrolled in a medical program or experienced medical transcriptionists preferred
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SCRIBE Job Description
Job Description Example
Our company is hiring for a SCRIBE. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for SCRIBE
- Develops work flows with clinicians and staff
- Acts as an ambassador to clinic scribes in working with multiple primary care clinics, traveling to other sites as needed
- Quality measures, assists in educating clinicians on quality measures, and develops plans to help clinicians meet these goals
- Lead scribes may also be asked to develop workflows with clinics outside of primary care such as Mental Health and Senior Care
- On occasion, lead scribes serve as IT liaisons to resolve technical problems quickly and effectively for clinicians, clinic staff, scribes, and other personnel
- Attends and assists with coding meetings while keeping presentation up to date, distributing materials, tracking attendance, and creating templates for clinicians
- Follows up with clinicians and coders to ensure understanding of proper billing and coding
- Performs medical administrative assistant duties for Emergency Department Physicians, including accompanying the assigned Physician during patient examinations in order to gather and accurately transcribe the patient history, physical data, and any other relevant information in the medical record
- Record any procedures performed and diagnostic tests ordered by the Physician
- Retrieve, collate, monitor and report laboratory, radiology and other diagnostic test results to the Physician in a timely manner
Qualifications for SCRIBE
- Experience with EHR preferred
- Must have excellent communication skills and be able to understand both written and oral instructions
- Prior experience as a medical scribe strongly preferred
- Athena and Meditech experience preferred
- Successful completion of a Medical Assistant, EMT or CNA training program a plus but not required
- Planning, training and consulting for NextGen and Allscripts EMR products other EMR supported platforms
5
SCRIBE Job Description
Job Description Example
Our growing company is hiring for a SCRIBE. Thank you in advance for taking a look at the list of responsibilities and qualifications. We look forward to reviewing your resume.
Responsibilities for SCRIBE
- Documents physical examination findings and procedures as performed by the physician
- Documents the correct time of patient care related activities, including physician-to-physician communication, family communication, and re-examination of the patient
- As and if permitted by hospital policies, document patient diagnoses, as determined and directed by the Physician
- Document any consultations with on-call physicians, specialists, or with other outside services
- Assist Physician with management of telephone calls to/for the Physician
- Assist with the facilitation and completion of admission, transfer and discharge forms and paperwork
- Review medical record for completeness and prepare for Physician signature
- Assist the Physician in keeping the patient and/or patient family informed to optimize patient satisfaction
- Assist Physician to expedite patient flow through organizational and communication skills
- Locate information for review (i.e., previous notes, reports, test results and laboratory results
Qualifications for SCRIBE
- Prior experience with on-site training of CIMs/Scribes
- Planning, training and consulting for office process flow and organizational initiatives within the company
- Develop and maintain role-based training curriculum
- Schedule training events as appropriate both a training center and at the physician offices as appropriate
- Accompany trainees to clinic and observe and evaluate documentation competencies to include HPI, PMH, ROS, Medications, Allergies, FHx, Instructions and Prescriptions
- Educate trainees on proper documentation of diagnoses, symptoms and diagnostic order entry