Ron Jones

About Ron Jones

Driven Executive Healthcare Leader with a proven track record of building out and maximizing revenue in the Payment Integrity (PI) and Claims space. Expertise in many facets of PI/Claims including Product/Innovation, Agentic AI, Solutions, Complexed Clinical Chart Review, Itemized Bill Review, DRG Validation, Data Mining/Payment Accuracy, Coding/Edits, Policies and Procedures, Contract Compliance, Coordination of Benefits, and Premium Restoration. Well versed at leveraging analytics, artificial intelligence, and machine learning, combined with great talent, to build \"best in class\" SaaS and/or services prepay, post pay, and pause and pay offerings. Over 25 years of experience in many sectors of healthcare, including operations management, finance, client relations, contract negotiation, research and development, ideation, sales, dental, medical, and legal.Currently, Vice President of Claims and Payment Integrity Solutions for Alaffia Health, I oversee the Product and Solution roadmap for our clinical, editing, generative AI, and contract compliance PI offerings, help develop and refine our short/long term business strategy, manage our client services and implementations teams, and collaborate with the sales division to drive additional opportunities. Duties also include: P&L, innovation, strategic planning/growth, and net new solutions.

Experience

1. Vice President, Claims Solutions

   Alaffia Health

   Feb 2025 — Present · NY, US

   Executive leadership role with a strong focus on Generative AI and end-to-end Clinical Claims Solutions; including but not limited to Utilization Management, Payment Integrity, and Appeals. Own client services, implementations, and solution development and assist with product management, operations and sales support. Collaborate with the C-Suite to plot short and long-term strategies, develop crucial roadmaps, execution, and overall company direction to ensure we are hitting sales and revenue targets while being a positive disruptor in the healthcare Claim Continuum space.

Education

• University of Louisville

  Business Administration and Management, General

Skills

• Customer Service
• Auditing
• Financial Analysis
• Client Liason
• Management
• Leadership
• Insurance
• Medicare
• Claim
• Contract Negotiation
• Data Analysis
• Consulting
• Business Analysis
• Access
• Healthcare Management
• Healthcare
• Analysis
• Medicaid
• Process Improvement
• Negotiation