Deltrois L. Newborn
Rahway,NJ
Summary
Accomplished healthcare professional with over 30 years of progressive experience in dental account management, Medicaid and Medicare dental operations, and customer service within the healthcare insurance industry. Proven expertise in regulatory compliance, quality assurance, and provider network management, with a robust background in overseeing state and DOBI complaints, managing Medicaid and Medicare dental programs, and leading continuous quality improvement initiatives. Demonstrates exceptional leadership skills and a commitment to delivering high-quality services and fostering a culture of excellence. Adept at streamlining operations to enhance efficiency and service delivery, with a strong focus on regulatory adherence and customer satisfaction.
Overview
36
36
years of professional experience
1
1
Certification
Work History
Dental Assistant
Independent Dental Consultant
Newark, NJ
02.2025 - 05.2025
- Dr Daniel Di Cesare (Owner) Ironbound Dental Newark, NJ
- Dr Glenwood Harper (Owner) Dental Office Orange NJ
- January 2024- December 2024 (weekends when needed)
Dental Account Management, Medicaid Dental Operations
Horizon Blue Cross Blue Shield of New Jersey
01.2014 - 10.2024
- Expertly handles state and DOBI complaints, ensuring resolution and maintaining compliance with regulatory standards. Performs meticulous quality assurance and quality control on customer service representatives' phone calls for the vendor SKYGEN USA. Exercises discretionary authority to approve or deny Modivcare services, demonstrating a thorough understanding of Medicaid dental operations and policies.
- Manager of Medicaid, Horizon NJ Health
- APRIL 2013 - JANUARY 2014
- Oversaw Medicaid and Medicare dental administration, ensuring the delivery of high-quality services and adherence to regulatory requirements. Directed the administration team, fostering a culture of excellence and continuous improvement. Streamlined operations to enhance efficiency and service delivery.
Manager of Medicaid
Horizon Dental
07.2000 - 03.2013
- Ensured compliance with all reporting requirements by coordinating production schedules and other reporting activities with dental program operations and systems staff. Collaborated with internal and external staff members to coordinate quality improvement activities, manage state audits, and implement continuous quality improvement initiatives. Demonstrated exceptional leadership in managing Medicaid and Medicare dental programs, ensuring optimal service delivery and regulatory adherence.
- Horizon Mercy Dental Coordinator
- JANUARY 1998 - JANUARY 2000
- Coordinated dental services under the Horizon Mercy program, ensuring seamless operations and compliance with program guidelines. Actively engaged with patients and providers to facilitate service delivery and address any concerns or issues. Played a pivotal role in enhancing the efficiency and effectiveness of the Horizon Mercy dental program.
Manager of Medicaid
Horizon Dental
NJ
07.2000 - 03.2013
- Ensured compliance with all reporting requirements by coordinating production schedules and other reporting activities with dental program operations and systems staff.
- Collaborated with internal and external staff members to coordinate quality improvement activities, manage state audits, and implement continuous quality improvement initiatives.
- Demonstrated exceptional leadership in managing Medicaid and Medicare dental programs, ensuring optimal service delivery and regulatory adherence.
Dental Coordinator
Horizon Mercy
NJ
01.1998 - 01.2000
- Coordinated dental services under the Horizon Mercy program, ensuring seamless operations and compliance with program guidelines.
- Actively engaged with patients and providers to facilitate service delivery and address any concerns or issues.
- Played a pivotal role in enhancing the efficiency and effectiveness of the Horizon Mercy dental program.
Customer Service Representative
12.1988 - 12.1997
- Delivered exemplary customer service, addressing inquiries and resolving issues with professionalism and efficiency. Demonstrated an in-depth understanding of Horizon BCBSNJ's services and policies, providing accurate and helpful information to customers. Contributed to the development of customer service protocols and procedures to enhance service delivery.
Customer Service Representative
Horizon BCBSNJ
NJ
12.1988 - 12.1997
- Delivered exemplary customer service, addressing inquiries and resolving issues with professionalism and efficiency.
- Demonstrated an in-depth understanding of Horizon BCBSNJ's services and policies, providing accurate and helpful information to customers.
- Contributed to the development of customer service protocols and procedures to enhance service delivery.
Education
Bachelor of Science - Business Management
University of Phoenix
Dental Assistant - undefined
Union College
Cranford, New JerseySkills
- Current Dental Radiology Licensure
- Certified Dental Assistant License
- CPR Basic Life Support (BLS) Certification
Certification
- [Area of certification] Training - [Timeframe]
Timeline
Dental Assistant
Independent Dental Consultant
02.2025 - 05.2025
Dental Account Management, Medicaid Dental Operations
Horizon Blue Cross Blue Shield of New Jersey
01.2014 - 10.2024
Manager of Medicaid
Horizon Dental
07.2000 - 03.2013
Manager of Medicaid
Horizon Dental
07.2000 - 03.2013
Dental Coordinator
Horizon Mercy
01.1998 - 01.2000
Customer Service Representative
12.1988 - 12.1997
Customer Service Representative
Horizon BCBSNJ
12.1988 - 12.1997
Dental Assistant - undefined
Union College
Bachelor of Science - Business Management
University of Phoenix
Personal Information
Title: Healthcare Manager, Dental Asistant