Mai Pha Email & Phone Number

Minneapolis, Mn, Us

Saint Paul, Mn, Us

Saint Paul, Mn, Us

• Conducted post-payment audits and investigations of Minnesota Health Care Providers (MHCP) claims to identify fraud, waste, and abuse on 34 active caseloads • Analyzed data and reviewed documentation from MHCP providers to ensure DHS policies and state statutes were followed for services and payments• Recovered between $100 and $500,000 from MHCP providers from investigations • Wrote clear and accurate investigative report of all complex activities, and testified at administrative hearings • Presented sanction recommendations and testified to a variety of groups such as peers, supervisors, managers, legal team, Asst. Inspector General, providers, opposing counsel, and administrative judges • A member of the OIG Equity Committee, created team charter and collaborated with other divisions within OIG to push Equity, Diversity, and Inclusion (EDI) agendas and strategies

St. Paul, Mn, Us

• Reviewed complaints against public health care providers utilizing state funded Medicaid program • Analyzed claims data, medical records, and financial records for fraudulent activities and abuse of Medicaid funds • Executed premise and electronic search warrants • Conducted interviews of targets, recipients, and providers • Wrote investigative reports and gathered evidence • Partnered closely with attorneys to prepare cases for prosecution

• Managed Hmong International Freedom Festival event budget of over $500,000 and worked closely with CEO to ensure all reporting are accurately and timely prepared, including appropriate narratives behind the numbers• Presented event income and expense report to Board of Directors on a weekly basis and provided status of financial condition by interpreting and reporting financial data to the board• Assisted CEO with reviewing financial KPIs to ensure budget and financial goals are attained• Created and prepared budget for 10 departments to ensure accuracy and ensure margin goals are met and provided guidance serving as SME

Us

• Researching potential overpayment scenarios • Identifying patterns of claim payments abnormalities through big data analysis• Develop metrics to forecast new algorithm profitability • Write business requirement documents for new algorithms and update existing documents as algorithm logic is developed or changes over time• Maintenance existing production algorithms to maximize performance while working directly with the programmers to test and implement changes• Completes monthly analysis of algorithm performance; forecasted vs. actuals

Us

• Assisted with complex and critical issues for the Post Pay business segment including process mapping and meeting with key stakeholders to implement quality program • Provided recommendations for process improvement by interpreting data collected from weekly, monthly, and quarterly reports • SME for Post Pay business process and share best practices with team members on Post Pay audits by engaging Quality Team via weekly and monthly calibrations• Lead multiple quality initiatives including timely audits, partnership with the business in remediating top errors, and continuous improvements with quality process• Coordinated and distributes weekly work assignment among 4 team members• Completes weekly, monthly, and quarterly quality reports and metric meeting business SLA

Us

• Triaged potential cases for fraud, waste, abuse, and error by auditing providers with unusual billing and claims patterns within payment integrity unit. • Researched provider licensing, background, and activities using various internal systems and external system such as Lexis Nexis – Accurint. • Prepared government reporting to comply with state and federal laws and regulations pertaining to audit findings, financial recovery, and health insurance abuse by providers. • Conducted patients’ interviews to confirm and verify services renders and bill of charges. • Calculated overpayment and prepare supporting documentations for recovery of dollar amount between $1,000 and $3,000,000. • Wrote internal policies and procedures fitting compliance and government regulations and train current and new employees on compliance policies and procedures. • Ran daily reports using SAS, conducting quality analysis on report ensuring accuracy and integrity of data. • Analyzed large and complex data set on Excel spreadsheet utilizing Pivot Table, V Lookup, and other various Excel functions to extract findings.• Collaborated and interacts with clinical team, legal, stakeholders, and upper management on complex audits with exposure exceeding $1,000,000.

Minneapolis, Mn, Us

•Partnered with TSYS on Target Canada Debit Card Project, reviewing, verifying, and approving daily average of 10 system change requests to mainframe platform. •Performed 2 hours daily testing ensuring system change requests are completed accurately and resolve issues with business partners minimizing operation impact. •Collaborated with internal business partners on system security findings; projects averaging $6,000 - $50,000, mitigating and remediating financial and compliance risks to close out findings. •Conducted100% quality control audit on 30-50 monthly system change requests ensuring accuracy and compliance with internal policies and procedures. •Write and implement system access and identity management control procedures, effectively communicate procedural changes to team members and management, and creates SharePoint site to store procedural documentations.

Dallas, Tx, Us

•Managed compliance and financial risk support to Wal-Mart, CVS, Circle K, and Save Mart, gathering financial data, evidence, compliance, and operational information for internal and external examinations. •Partnered closely with FIU and Credit teams to address agents’ lack of compliance, financial and fraud risks on company products and services. •Exceeded departmental expectations and analyzed over 560 monthly international money transfer alerts for fraud, money laundering, drug trafficking, and suspicious activities; completing investigative report for government reporting. •Conducted 54 monthly financial audits using Norkom and Global Compliance risk management systems for high risk countries such as Pakistan, Italy, United Arab Emirates and Canada for financial crimes.•Reviewed 635 money order alerts and conducted over 34 monthly complex money orders audits reducing average of $300,000 in financial and fraud losses for the enterprise. •Executed Office of Foreign Assets Control (OFAC) findings and completed work processes to add monthly average of 260 high risk customers to internal denial list. •Filed over 200 monthly Suspicious Activities Report (SAR) and Currency Transaction Report (CTR) with monthly average of $380,000 reported to FINCEN and FINTRAC. •Bulit strong relationship with IT and successfully designed and implemented 5 CRM databases identifying financial risks, fraud, money laundering, and suspicious activities. •Performed 120 monthly quality control audits, reviewing team members’ work ensuring accuracy, addressed deficiencies and errors, and provided feedback to 8 compliance specialists. •Recognized by management as employee of the month for implementing an automated process for daily reviews of transactions reducing SLA by 50%. •Successfully lead ongoing AML/BSA, work processes and procedures training to internal team members utilizing MS Visio for process mapping and PowerPoint for presentation.

Dallas, Tx, Us

•Conducted analysis and trending of online money transfer transactions for fraud and suspicious activities and executed real time decisioning on over 200 daily alerts in a fast pace customer service driven environment. •Researched high level KYC (Know Your Customer) on 100 customer accounts daily using Lexis Nexis and reviewing supporting documentations with high accuracy in a fast past environment. •Lead in various fraud prevention projects, prioritizing tasks, delegation of duties to team members, and follow through ensuring project success.

Minneapolis, Mn, Us

•Analyzed and investigated over 500 weekly credit card transaction alerts with monthly average dollar amount of $2,000,000 for fraud and financial risks through Total System (TSYS) platform while maintaining excellent phone stats. •Reviewed daily average of 20 new accounts for Know Your Customer (KYC) due diligence using Lexis Nexis and analyzing ad-hoc reports reducing fraud financial risks by 30% to the enterprise. •Collaborated with business partners to provide fraud findings, Initiated fraud disputes and escalation process.

Bachelor'S Degree, Business Administration

A.S, Business Management