Healthcare Management Solutions

What Healthcare Management Solutions does

Healthcare Management Solutions, LLC is a Jacksonville, Florida-based healthcare compliance and revenue cycle consulting firm founded in 2004. The company delivers seven core professional services: healthcare compliance program development, medical chart auditing (quarterly, AAPC-certified), Recovery Audit Contractor (RAC) audit preparation and response, remote and on-site medical coding by CPC/RHIT-certified professionals, denials management and appeals, practice management consulting, and provider credentialing including PECOS/CAQH maintenance and payer negotiation. Service delivery targets medical practices of all sizes — solo, group, multi-specialty, and academic — across more than 20 specialties including Orthopedics, Oncology, Neurology, Emergency Medicine, Wound Care, OBGYN, Cardiology, and Family Practice, with both on-site and remote engagement models. The business is operated by a small (1-10 employee) team led by founder/CEO Gianni Gonzalez (CPC, CPMA, RHIT, CMCO), supported by an advisor (Judi Lento, 30+ years) and a Director of Behavioral Health (Theresa Roman, Psy.D); the firm is a privately held, bootstrapped LLC with no external funding or institutional investors.

The go-to-market is a B2B sales-led model relying on professional association affiliations (AAPC, AHIMA, MGMA, NAMAS), content marketing through an educational blog, customer testimonials, and direct inbound contact via website forms and phone. All services are quote-based, customized to practice size and specialty complexity, and structured as multi-year professional services engagements; pricing is not publicly disclosed. Customer outcomes cited include 5%+ audit score improvement, 90% reduction in denied claims, and 2-3x revenue gains at named clients, though these are company-reported rather than third-party validated.

Technology posture is lightweight: the firm leverages industry-standard EMR/EHR integration and certified human processes rather than proprietary platforms, and references AI modalities (NLP, computer-assisted coding, anomaly detection, predictive analytics) as industry capabilities rather than as deployed products. Operating geographies are listed as the Southeast US, but the remote-delivery model implies latent national reach.

Name

Healthcare Management Solutions

Legal name

HealthCare Management Solutions, LLC

Website

https://medicalcodingaudits.com

Company type

Private

Founded year

2004

Operating status

Operating

Headcount range

1–10 employees

Short description

Healthcare Management Solutions is a Jacksonville, FL-based healthcare compliance and coding consulting firm serving US medical practices of all sizes across 20+ specialties with audit, coding, denials management, RAC audit, and provider credentialing services.

Ownership category

akta.pro rank

Product category

Healthcare Compliance and Medical Auditing Services

NAICS

Management Consulting Services (54161)

SIC

Services-Health Services (8000)

akta.pro industry

PRIMARYBPAAAFAD

Medical Coding, Billing & Clinical Documentation Support

Business & Public Services/Administrative & Support Services (BPO, Call Centers, Back Office)/Claims Processing & Adjudication Support

SECONDARYHLACAAAO

Clinical Coding Support (ICD/CPT/SNOMED) & Documentation Compliance Tools

Healthcare & Life Sciences/Digital Health & Health IT/Electronic Health Records (EHR/EMR) & Clinical Documentation

Keywords

• Medical chart auditing
• Healthcare compliance
• Medical coding services
• Denials management
• Provider credentialing

Headquarters

HQ city

Jacksonville

HQ country

United States

HQ region

North America

Offices1 record

Markets served

GTM type

B2B

Offering type

Services

Cost components

Personnel, Operations, Marketing or Sales, Technology or R&D

Revenue model

1. Healthcare Compliance Services: Compliance consulting including policy development, staff training, and ongoing compliance program management for medical practices.
2. Medical Chart Auditing: Chart auditing services to identify documentation issues, coding errors, and compliance risks before external audits occur.
3. RAC Audit Services: Recovery Audit Contractor preparation and response services to help practices defend against Medicare audit requests.
4. Medical Coding Services: Remote and on-site medical coding services providing accurate charge capture, clean claims submission, and coding compliance.
5. Denials Management: Claims denial management, appeal processing, and root cause analysis to reduce denial rates and improve cash collections.
6. Provider Credentialing: Provider enrollment services including application filing, payer negotiation, PECOS/CAQH maintenance, and demographic changes for insurance credentialing.
7. Consulting Services: Practice assessment, billing improvement, operational flow analysis, practice management, and fee schedule analysis services.

Pricing tiers

Go-to-market motion1 record

Distribution channels3 records

Marketing channels6 records

Core offering

Healthcare Management Solutions provides outsourced medical chart auditing, medical coding, RAC audit defense, denials management, provider credentialing, and healthcare compliance consulting services to physician practices and healthcare providers. The firm is structured as a boutique services practice, deploying certified coders and auditors to perform chart reviews, recover denied or underpaid claims, support credentialing with payers, and advise providers on regulatory compliance risks.

Product overview

Healthcare Management Solutions provides a comprehensive suite of healthcare revenue cycle management and compliance services. The company offers seven core service modules: Healthcare Compliance Services (regulatory compliance programs), Medical Chart Auditing (AAPC-certified quarterly audits), RAC Audits (Recovery Audit Contractor preparation), Medical Coding Services (CPC/RHIT certified coders), Denials Management (claims denial resolution), Consulting Services (practice assessment and optimization), and Provider Credentialing (payer enrollment). These services are designed for medical practices of all sizes and work with EMR/EHR systems to help practices maintain compliance, improve revenue, and reduce denials.

Differentiator

Problem solved

Functional benefit

Products and services

• Medical Chart Auditing Outsourced review of patient medical charts to assess coding accuracy, documentation completeness, and compliance, intended for physician practices and healthcare providers seeking to reduce RAC/payer audit exposure and identify underpayments.
• RAC Audit Defense Support service that helps physician practices respond to Recovery Audit Contractor (RAC) audits and other payer-initiated audits, providing documentation preparation, response drafting, and appeal management.
• Medical Coding Services Certified-coder-driven medical coding review and assignment services for physician practices and healthcare providers, aimed at improving coding accuracy, reducing denials, and ensuring appropriate reimbursement.
• Denials Management Management and appeal of denied or underpaid medical claims, helping physician practices recover revenue by reviewing denial reasons, preparing appeals, and resubmitting corrected claims to payers.
• Provider Credentialing Credentialing and re-credentialing of physicians and providers with commercial payers, Medicare, and Medicaid, intended to reduce administrative burden on practices and ensure providers remain in good standing with health plans.
• Healthcare Compliance Consulting Advisory and consulting engagements that help physician practices and healthcare providers interpret and adhere to healthcare regulations, including documentation standards, billing compliance, and audit readiness.

Quantifiable outcome

• 5%+ improvement in overall audit scores
• +4 more outcomes

Named customers9 records

Segments4 records

Ideal customer profiles1 record

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

AI capability5 records

Partnerships

Six partnerships are on record, tiered core and supporting.

• AAPC (American Academy of Professional Coders)coreOthersProfessional affiliation with AAPC, the authority in training and credentialing physician coders. Company team members hold CPC (Certified Professional Coder) and CPMA (Certified Professional Medical Auditor) certifications through AAPC.
• AHIMA (American Health Information Management Association)coreOthersProfessional affiliation with AHIMA. Founder Gianni Gonzalez holds RHIT (Registered Health Information Technician) certification through AHIMA.
• MGMA (Medical Group Management Association)coreOthersProfessional affiliation and thought leadership connection with MGMA. Judi Lento has consulted with MGMA on industry matters.
• NAMAS (National Alliance of Medical Auditing Specialists)supportingOthersProfessional affiliation with NAMAS for medical auditing expertise and resources.
• OIG (Office of Inspector General)supportingOthersReference to OIG compliance guidelines and resources as part of healthcare compliance services.
• EpiCompliancesupportingTechnology or IntegrationReferenced as a HIPAA compliance online resource partner for healthcare compliance services.

Scale indicators13 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• AGS Health: AGS Health (parent of Aviacode) is a larger but directly comparable provider of coding, auditing, denial management, and RCM services to hospitals and physician groups. It operates in the same core service categories as HCMS at greater scale.
• Aviacode: Aviacode (now part of AGS Health) provides medical coding, auditing, and clinical documentation improvement services to hospitals and physician practices. It is one of the closest direct competitors to HCMS in human-led coding and audit services.
• Himagine Solutions: Himagine Solutions is a HIM outsourcing firm providing medical coding, auditing, cancer registry, and clinical documentation services. It directly overlaps with HCMS on certified-coder-driven coding and audit offerings for healthcare providers.
• AdvantEdge Healthcare Solutions: AdvantEdge provides medical billing, coding, and full revenue cycle management for medical practices and ambulatory surgery centers. It is a comparable services-led RCM competitor with similar customer profiles.
• M-Scribe: M-Scribe provides outsourced medical coding, billing, and chart auditing services to medical practices and ambulatory surgery centers. It is a direct competitor in remote coding and audit delivery for small and mid-sized practices.

Emerging players

• CodaMetrix: CodaMetrix applies AI/NLP to autonomous medical coding for hospitals and health systems. It is an emerging threat/peer that targets the same coding workflow that HCMS serves with human coders, but via a technology-first model.
• AKASA: AKASA builds AI-driven revenue cycle automation for health systems, including coding, claims, and denials workflows. It represents the technology-led frontier of the same RCM services that HCMS delivers manually.

Broad incumbents

• Optum (UnitedHealth Group): Optum's Revenue Cycle Services unit offers coding, billing, denial management, and consulting at enterprise scale. It is a broad incumbent that competes for the same hospital and large practice engagements that HCMS targets.
• Solventum (formerly 3M Health Information Systems): Solventum (spun out of 3M) provides coding, classification, and clinical documentation software and services. It is a broad incumbent competing across coding tools and outsourced services that intersect with HCMS's offerings.

Others

• AAPC: AAPC is the professional association that trains and credentials medical coders (CPC, CPMA). It is an ecosystem participant — a referral source and standards body for HCMS's certified staff — rather than a direct competitor.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights6 records

Customer concentration

• Xx.com/HealthcareMgSol
• Facebookfacebook.com/healthcaremanagementsolutions
• LinkedInlinkedin.com/company/medicalcodingaudits

Compliance2 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Healthcare Management Solutions