Job Description
Job Description
- Works under the supervision of the Medical Secretary Supervisor. Responsible for transcribing dictated medical reports, operative reports, consultation reports, discharge summaries and radiological reports. Coordinates
with the nursing department & Doctors
Responsibilities
- Transcribe Recordings to Type-Written Format using Keyboard, Computer, and Audio Control Equipment.
- Transcribe and interprets the dictation to provide permanent records of patient care, i.e., Operative Reports, Consultation Reports, and Discharge Summaries etc.
- Identify inconsistencies, errors, and missing information within a report that could compromise patient care.
- Follow up with the healthcare provider to ensure the accuracy of the reports.
- Submit health records for physicians to approve.
- Complete the health records within the turnaround time maintaining utmost confidentiality.
- Submit Transcribed Documents for Inclusion in Official Hospital Records.
- Carry out technical analysis and evaluation of medical records in accordance with accreditation standards.
- Evaluate medical record documentation for deficiencies in the Outpatient medical records and to arrange for completion of records with the cooperation of medical and nursing staff.
- Demonstrate an understanding of the medico-legal implications and responsibilities related to the transcription of patient records to protect the patient and the hospital.
- Operate the designated word processing, dictation, and transcription equipment as directed to complete assignments.
- Expand job-related knowledge and skills to improve performance and adjust to change.
- Perform other duties and tasks within the realm of his/her knowledge and ability as required.
Qualifications
• Bachelor’s Degree
• Successful completion of a recognized medical transcription training program preferred.