Chuck Buseck
Chief Operating Officer at Maryland Physicians Care- Claim this Profile
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Bio
Credentials
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Unconscious Bias V3.1
TraliantJul, 2022- Nov, 2024
Experience
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Maryland Physicians Care
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United States
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Insurance
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1 - 100 Employee
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Chief Operating Officer
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Nov 2018 - Present
Responsible for the oversight of Maryland Physicians Care's downstream administrator delegated functions e.g. claims processing, payment integrity, appeals management, customer service, etc... Leads team that has direct management of Maryland Physician Care's provider network assessment and strategic network management to increase access to high quality providers. Creates and executes Marketing Strategy for 235,000+ statewide Medicaid managed care organization, ultimately leading cross functional team to maximize community engagement and program development. Business lead for 2021 TPA conversion, including due diligence and implementation.
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Avēsis
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United States
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Insurance
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300 - 400 Employee
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Assistant Vice President, Account Management
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Jul 2016 - Nov 2018
Responsible for leading the Government Account Management team. Develops annual corporate client strategy while overseeing client relationship development and maintenance with over 50 national and regional health plan Medicaid and Medicare product partnerships as well as direct-to-state dental carve out programs (CA and UT). -Developed and executed relationship management strategy leading to 100% client retention-Business owner for UT Medicaid RFP response, successfully reprocuring the existing business while expanding the contract service area statewide-Renegotiated several contracts for additional multiyear terms-Directed implementation of first client survey to attain baseline for future comparison-Business owner for migration of data from sister company's legacy system to Avesis' platform-Created monthly Risk Assessment meeting, empowering staff to present their financial trending and program loss ration analysis to Management Team-Hired and positioned Director, Quality Programs to increase HEDIS Annual Dental Visit and Diabetic Retinal Exams as well as other CMS measures (delivering pilot program to market as well as positive outcomes)
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Director, Account Management
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Jan 2015 - Jun 2016
Directly responsible for managing the Health Plan Account Management team, overseeing over 40 client relationships with Medicaid and Medicare health plans. Accountable for the growth, development and scalability of the department across a growing organization.-Guides clients through critical compliance, financial, contracting and operational business issues within highly regulated and financially restrictive Medicaid and Medicare environments-Accountable for leadership and performance of Account Executives and Account Coordinators-Created new service model, focusing Account Managers’ day to day responsibilities to provide greater efficiency, yet including cross-training for scalability-Developed and defined multiple roles within the department, providing a clear entry point and path for career growth-Implemented in-person, quarterly department meetings focused on strengthening relationships, team bonding, and increasing business aptitude
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DentaQuest
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United States
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Hospitals and Health Care
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700 & Above Employee
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Regional Director, Client Services
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Mar 2011 - Oct 2014
Responsible for developing strong client relationships, ensuring contract retention, participating in financial management and supporting new business growth in assigned market.Managed contracting requirements and negotations for existing clients involved in additional services and/or renewing contracts with DentaQuest. Acountable for leadership and performance of Executive Directors and Account Executives within market. Ensured best use of resources by defining and planning departmental strategies and long-range goals. Coordinated cost management and cost analysis activities. Managed to annual loss ratio goals for risk clients. Managed operational costs through appropriate budget management with the client, creating efficient processes or workarounds when appropriate. Managed assigned budget.-Quality Oversight Committee Member - Since April 2010 thru October 2014-Tactical Kill The Issues Committee Lead - July 2011 thru June 2012-Recognition Committee Member - January 2011 thru December 2013
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Executive Director
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Jan 2006 - Feb 2011
Primary liaison with ODM contracted, Medicaid managed care plans and internal operational departments, overseeing daily market operations and maintaining client contract compliance. Completed multiple Medicaid and Medicare product implementations and led program expansion.-Managed completion of a statewide provider network expansion from 10 to 88 counties -Directed statewide market Provider Relations staff -Hired additional staff to increase proactive servicing efforts-Expanded Colgate’s mobile dental program service area-Created market Dental Advisory Committee, developing a forum for key participating providers and the Ohio Dental Association to discuss program changes and further identify program needsExpanded role included oversight of client relations with Medicaid managed care plans in MD and the District of Columbia.
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Ion Health
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Erie, PA
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Manager, Vendor Relations
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Jul 2002 - Dec 2005
Start-up Medicaid managed care organization established in 2002. Membership within PA Department of Public Welfare's voluntary service area in NW PA. Responsible for managing Dental, Vision, Pharmacy, and Home Health vendors. -Lowered PMPM costs in respective areas -Reviewed Requests for Proposals for vision vendors and successfully implemented new vision vendor -Monitored contract compliance with associated vendors Prior roles within the organization included: Territory Manager, Provider Contracting Manager, Provider Services Manager, Credentialing Provider Contracting Representative
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Education
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2008 - 2010
The Ohio State University - The Max M. Fisher College of Business
MBA -
1998 - 2002
Allegheny College
BS, Biology
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