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Medical Assistant Scribe

EXPRESS PAIN AND URGENT CARE PLLC

Job Description

Job Description

Description:

Medical Assistant 

Description

Medical Assistant Scribe | Pain Management

Full-Time | Monday–Friday, 8:00 AM – 5:00 PM

We’re looking for an experienced, detail-oriented Medical Assistant Scribe to provide direct clinical and documentation support to our physicians and advanced practice providers (MDs, NPs, and PAs).

Previous pain management experience is required for this position. This position will travel between Epic Pain Management locations throughout the San Antonio area based on provider schedules and operational needs. Candidates must have reliable transportation and the ability to report to different San Antonio clinic locations as assigned.

This is a fast-paced clinical role requiring excellent attention to detail, strong EMR skills, and the ability to accurately document patient encounters in real time.

Why Join Epic?

At Epic, every patient interaction matters. You’ll work directly with our providers and clinical team to support accurate documentation, efficient patient flow, and high-quality patient care.

Benefits include:

  • PTO, paid holidays & 401(k) with 4% employer match
  • 80% employer-paid medical insurance for employees, plus optional low-cost dental, vision, and family plans
  • Pet insurance, legal insurance, identity theft protection, travel insurance, and employee discount programs

About the Role

As a Medical Assistant – Scribe , you will work alongside the provider throughout daily patient visits. You will prepare the provider for each encounter, accompany the provider into the exam room, document examination findings and treatment plans, assist with orders, and ensure the patient's chart accurately reflects the provider's assessment and plan.

You will also assist with procedure preparation, imaging reviews, medication documentation, urine drug screening (UDS), Prescription Monitoring Program (PMP) reviews, clearances, and patient instructions.

Key Responsibilities

Provider & Patient Visit Support

  • Provide direct support to physicians, nurse practitioners, and physician assistants throughout daily patient visits
  • Review patient charts before the provider encounter to ensure required documentation is complete, including vitals, medications, allergies, medical history, and review of systems (ROS)
  • Brief the provider on the reason for the patient's visit, including new patient visits, follow-ups, post-operative visits, procedure follow-ups, and medication management
  • For procedure follow-ups, identify the procedure performed, injection/ESI sequence when applicable, and the patient's reported percentage of pain relief
  • Prepare and print imaging reports for provider review as requested
  • Accompany the provider into the exam room during patient encounters
  • Help maintain efficient patient flow throughout the clinic

Scribing & EMR Documentation

  • Accurately scribe patient encounters in the EMR in real time as directed by the provider
  • Document physical examination findings communicated by the provider
  • Accurately update the patient's assessment and plan
  • Enter or prepare orders as directed by the provider, including procedures, injections, appropriate spinal levels, imaging, medications, and other treatment orders
  • Enter diagnosis codes based on provider direction and supporting documentation
  • Review and document Prescription Monitoring Program (PMP) information as required
  • Review, update, and document urine drug screening (UDS) information as directed
  • Maintain accurate and timely documentation throughout each patient encounter
  • Ensure charts are complete and ready for provider review and signature

Pain Management & Procedure Coordination

  • Support documentation and coordination for interventional pain management procedures
  • Maintain familiarity with common pain management procedures, including epidural steroid injections (ESIs), medial branch blocks, radiofrequency ablations, and other interventional procedures
  • Confirm procedure type, location, spinal level, and other required information as directed by the provider
  • Ensure treatment orders match the assessment and plan documented in the patient's chart
  • Identify discrepancies between provider documentation and treatment orders and address them before the encounter is completed
  • Assist with imaging, procedure, and follow-up orders as directed

Medication, UDS & Clearance Support

  • Accurately document medications and medication changes as directed by the provider
  • Review PMP information and UDS results as required by the provider
  • Identify and document patients currently taking blood-thinning medications
  • Assist with obtaining required medical clearance when a patient may need to discontinue a blood thinner before a procedure
  • Prepare and fax appropriate clearance documentation to the prescribing provider as directed
  • Assist with cardiac or other medical clearance coordination when required

Patient Education & Check-Out Preparation

  • Provide patients with appropriate documents and instructions related to procedures, imaging, referrals, and follow-up care
  • Review and explain pre-procedure instructions
  • Ensure patients understand how to prepare for upcoming procedures
  • Communicate provider-directed instructions clearly and professionally
  • Confirm that treatment orders and patient instructions match the documented treatment plan
  • Escort patients to check-out once the clinical encounter and required documentation are complete
Requirements:

Requirements

Qualifications

  • Previous pain management experience is required
  • Previous experience as a Medical Assistant in a pain management practice 
  • Medical scribe or provider-scribing experience strongly preferred
  • Certified or Registered Medical Assistant preferred
  • Working knowledge of interventional pain management procedures and terminology
  • Familiarity with pain management injections, spinal levels, procedure follow-ups, imaging, medications, PMP reviews, and UDS documentation
  • Strong understanding of medical terminology, anatomy, medications, and clinical documentation
  • Proficiency with electronic medical record (EMR) systems
  • Strong typing and computer skills with the ability to document accurately in real time
  • Exceptional attention to detail and documentation accuracy
  • Strong organizational and multitasking abilities
  • Excellent written and verbal communication skills
  • Professional and compassionate patient-service skills
  • Ability to work directly alongside a provider in a fast-paced clinical environment
  • Bilingual English/Spanish highly preferred
  • Dependable, organized, and able to work effectively as part of a clinical team
Preferred Experience
  • Interventional pain management
  • Provider scribing
  • Pain management EMR documentation
  • Epidural steroid injections (ESIs)
  • Medial branch blocks
  • Radiofrequency ablations
  • Medication management
  • PMP review and documentation
  • Urine drug screening (UDS)
  • Imaging and procedure coordination
  • Pre-procedure and medical clearance workflows

Vacancy posted a month ago
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