Customer Service Representative - Transitional Care Services (Remote)

Position Objective:

The Customer Service Representative is responsible for delivering high-quality, timely, and accurate customer service to patients enrolled in the Transitional Care Program, their caregivers, and internal hospital teams. This role combines strong communication, problem-solving, and care-coordination skills with meticulous documentation and use of electronic health record (EHR) systems. The CSR acts as a liaison between patients, transition nurses, case managers, community resources, and external vendors to ensure a seamless discharge process and adherence to individualized follow-up plans designed to reduce readmission risk.

Essential Job Duties:

1. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions:
2. Conduct outbound and inbound calls to patients and caregivers within defined timeframes post-discharge (e.g., within 24–72 hours) to confirm discharge instructions, medication plans, follow-up appointments, and care needs.
3. Answer patient/caregiver inquiries related to transitional care services, appointment scheduling, transportation, durable medical equipment (DME), home health, and other community resources.
4. Provide clear, empathetic, culturally sensitive guidance; escalate clinical or urgent issues to clinical staff per protocols.
5. Coordinate follow-up appointments with primary care providers, specialists, home health agencies, and home equipment suppliers based on individualized care plans.
6. Initiate referrals and schedule services through vendor portals, referral platforms, or direct provider outreach; track referral completion.
7. Accurately document all patient interactions, outreach attempts, outcomes, and escalations in the EPIC within required timelines.
8. Work collaboratively with inpatient teams to address barriers preventing safe discharge or timely follow-up.
9. Meet performance targets for call volumes, outreach success rates, documentation timeliness, and referral completions as set by program leadership.
10. Participate in shift coverage, periodic evening or weekend outreach (if required), and cross-training to support program needs.

Required Education/ Experience/ License and Certifications: 

• High school diploma or GED required
• Minimum 2 years of customer service experience in healthcare, care coordination, case management support, or related setting. Experience working with hospital discharges, home health, or community resources highly desirable.
• Strong verbal and written communication skills; ability to convey medical and logistical information in plain language.
• Proficiency with EPIC and common office software (Microsoft Office Suite, email).
• Demonstrated ability to manage multiple priorities, work independently, and meet measurable performance targets.
• Reliable attendance, punctuality, and ability to work scheduled shifts
• Handle high-volume outreach while prioritizing urgent matters.
• Experience with transitions of care, readmission prevention initiatives, or chronic disease management preferred.

Working Conditions, Equipment, Physical Demands:

There is a reasonable expectation that employees in this position will be exposed to blood-borne pathogens.

Physical Demands -

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

The above job description is an overview of the functions and requirements for this position.  This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.