Medical Assistant (Documentation Assistant) - Behavioral Health Consultation - Liaison Service - PT - Other

Documentation Assistant

This position spends a high percentage of time performing medical transcription duties as a "real time" Documentation Assistant for a specific physician. Time is spent routing and processing documentation and delivering reports to physicians for review in a timely manner. Core responsibility is to capture accurate and detailed documentation of the patient encounter in a real time manner. Member uses acquired, office-based skills to assist physicians and nursing personnel to maintain smooth working order of the offices, continuity of patient care and client satisfaction.

All documentation assistant entries must contain an entry made by the provider that - Affirms the providers presence during the time the encounter was recorded -Verification that provider reviewed the information - Verification of the accuracy of the information - Provider authentication including date and time

Assist the provider in navigating the EHR. Respond to various EHR messages as directed by the provider. Enter information into the EHR as directed by the provider. Relay all advisories or alerts that appear while scribing to obtain guidance from Provider on proper response. Ensure that all entries in the EHR by the Documentation Assistant are authenticated by the Documentation Assistant including date and time.

Locate information for review (i.e. previous notes, reports, results, etc.). Obtains vital signs, medication list, allergies, simple patient history information accurately. Knowledgeable of correct set-up and procedures to safely perform ear irrigation, monitor oxygen via mask and nasal cannula, assist with suture care and removal.

Receives telephone messages and appropriately relays these messages to the physicians and nurses. Assists with callbacks as indicated to deliver prompt, prioritized patient care (patient, pharmacies, insurance companies, etc.). Schedules consults and follow up appointments.

Complete In basket work such as result notes at direction of provider, order information, and patient schedule.

Relay all advisories or alerts that appear while scribing to obtain guidance from Provider on proper response.

Obtain medication and procedure prior authorizations.

Applies proper techniques with hand washing, instrument handling and care, care and cleaning of exam rooms and equipment and determination of when and how to use personal protective clothing/equipment.

Assists with simple patient teaching: procedures, laboratory tests, medications, etc.

Maintains exam rooms with necessary supplies and materials. Prepares list of supplies needed. Checks expiration dates.

May assist with wound care and cast care.

Assists with Code Blue events and transfers to hospital.

Efficiently documents medical information using the appropriate electronic applications and/or forms.

Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health

Performs other duties as assigned

Position is Patient Facing

Workspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards.

Stable access to electricity and a minimum of 25mb upload and internet speed.

Dedicate full attention to the job duties and communication with others during working hours.

Adhere to break and attendance schedules agreed upon with supervisor.

Abide by Stormont Vail's Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually.

On-Site; No Remote

No Supervisory Responsibility

No Budget Responsibility

Balancing: Occasionally 1-3 Hours

Carrying: Occasionally 1-3 Hours

Climbing (Ladders): Rarely less than 1 hour

Climbing (Stairs): Rarely less than 1 hour

Crawling: Rarely less than 1 hour

Crouching: Occasionally 1-3 Hours

Driving (Automatic): Rarely less than 1 hour

Driving (Standard): Rarely less than 1 hour

Eye/Hand/Foot Coordination: Frequently 3-5 Hours

Feeling: Occasionally 1-3 Hours

Grasping (Fine Motor): Frequently 3-5 Hours

Grasping (Gross Hand): Occasionally 1-3 Hours

Handling: Occasionally 1-3 Hours

Hearing: Frequently 3-5 Hours

Kneeling: Occasionally 1-3 Hours

Lifting: Occasionally 1-3 Hours up to 25 lbs

Operate Foot Controls: Rarely less than 1 hour

Pulling: Occasionally 1-3 Hours up to 25 lbs

Pushing: Occasionally 1-3 Hours up to 25 lbs

Reaching (Forward): Occasionally 1-3 Hours up to 25 lbs

Reaching (Overhead): Occasionally 1-3 Hours up to 25 lbs

Repetitive Motions: Frequently 3-5 Hours

Sitting: Frequently 3-5 Hours

Standing: Frequently 3-5 Hours

Stooping: Rarely less than 1 hour

Talking: Occasionally 1-3 Hours

Walking: Frequently 3-5 Hours

Burn: Rarely less than 1 hour

Chemical: Rarely less than 1 hour

Combative Patients: Occasionally 1-3 Hours

Dusts: Rarely less than 1 hour

Electrical: Rarely less than 1 hour

Explosive: Rarely less than 1 hour

Extreme Temperatures: Rarely less than 1 hour

Infectious Diseases: Occasionally 1-3 Hours

Mechanical: Rarely less than 1 hour

Needle Stick: Occasionally 1-3 Hours

Noise/Sounds: Occasionally 1-3 Hours

Other Atmospheric Conditions: Rarely less than 1 hour

Poor Ventilation, Fumes and/or Gases: Rarely less than 1 hour

Radiant Energy: Rarely less than 1 hour

Risk of Exposure to Blood and Body Fluids: Occasionally 1-3 Hours

Risk of Exposure to Hazardous Drugs: Rarely less than 1 hour

Hazards (other): Rarely less than 1 hour

Vibration: Rarely less than 1 hour

Wet and/or Humid: Rarely less than 1 hour

Stormont Vail is an equal opportunity employer and adheres to the philosophy and practice of providing equal opportunities for all employees and prospective employees, without regard to the following classifications: race, color, ethnicity, sex, sexual orientation, gender identity and expression, religion, national origin, citizenship, age, marital status, uniformed service, disability or genetic information. This applies to all aspects of employment practices including hiring, firing, pay, benefits, promotions, lateral movements, job training, and any other terms or conditions of employment.

Retaliation is prohibited against any person who files a claim of discrimination, participates in a discrimination investigation, or otherwise opposes an unlawful employment act based upon the above classifications.