Professional Medical Billers Association USA

What Professional Medical Billers Association USA does

Professional Medical Billers Association USA (PMBAUSA LLC) is a private medical coding and billing education company headquartered in Denver, Colorado, with operational and curriculum development managed through its wholly-owned subsidiary MEDESUN Prime Medical Coding Academy in Hyderabad, India. Founded in 2009, PMBAUSA delivers a portfolio of advanced certifications (CMCC®, CPMB®, CAIMC®, CHA™, CMC®), 15+ specialty fellowships covering HCC/risk adjustment, inpatient, surgery, neurology, ophthalmology, dermatology, orthopaedic, OB-GYN, gastroenterology, anaesthesia, SNF, and health information management, plus internship services through CodersGrade® and professional services including medical coding auditing, HCC-risk adjustment coding, hospital/surgery coding, end-to-end RCM, ICD-11 implementation, and AI medical coding software development and testing. The company targets already-certified medical coders (CPC, CCS, CRC holders) primarily in India, USA, and UAE seeking specialty advancement, with an AI-integrated curriculum featuring GPT-4 fine-tuning, NLP-driven documentation analysis (John Snow Labs, Amazon Comprehend), and AI compliance workflows.

PMBAUSA operates a fully online, self-serve, product-led growth distribution model. All certifications and fellowships are sold via e-commerce on pmbausa.com, processed through Razorpay, and delivered through the ProProfs learning management platform, with CHA™ certification administered via partner ecfirst.com. Revenue is generated through one-time certification and fellowship fees (ranging $49–$600), subscription-based medical coding auditing at $685/month per provider, managed-services RCM and coding engagements contracted via email, and $49/3-year credential renewals. Freemium entry points — free CPMB training, free CMCC® Beta Test, free CodersGrade internship, and free membership — drive top-of-funnel acquisition, with paid credentials, specialty fellowships, and enterprise services serving as conversion products. The company has credentialed 9,000+ professionals across 80+ countries, holds IAO full accreditation and CPD UK membership, and was named Emerging AI Medical Coding & Billing Academy 2025 at the Global Business Summit in Hyderabad.

The underlying technology stack combines a self-paced online LMS (ProProfs), AI-curriculum tools covering GPT-4 customization, NLP pipelines, and anomaly/fraud detection, plus integrations with Razorpay for payments, CredsVerse for credential verification, and John Snow Labs/Amazon Comprehend for NLP training. The company is bootstrapped with no disclosed external funding, is founder-led by Dr. Santosh Kumar Guptha (50+ credentials, 22+ years experience) with CEO Jared Heaton overseeing commercial operations, and maintains 11–50 employees across its Denver headquarters and Hyderabad operations center.

Name

Professional Medical Billers Association USA

Legal name

Professional Medical Billers Association USA LLC

Website

https://pmbausa.com

Company type

Private

Founded year

2009

Operating status

Operating

Headcount range

11–50 employees

Short description

PMBA USA is a Denver-headquartered, online medical coding and billing education company that delivers advanced certifications, 15+ specialty fellowships, and AI-integrated training for already-certified CPC/CCS/CRC coders primarily in India, USA, and UAE, supplemented by enterprise RCM, auditing, and coding services.

Ownership category

akta.pro rank

Product category

Medical Coding Education and Certification Training

NAICS

Other Scientific and Technical Consulting Services (54169)

SIC

Services-Management Services (8741)

akta.pro industry

PRIMARYEDAOAJAE

Medical Billing, Coding & Revenue Cycle

Education/Vocational, Technical & Trade Education/Healthcare Allied & Clinical Support Training

Keywords

• Medical coding certification
• Medical billing training
• Healthcare coding fellowships
• HCC risk adjustment coding
• Revenue cycle management services

Headquarters

HQ city

Denver

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2B and B2C

Offering type

Services

Cost components

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

Revenue model

1. Professional Certification Programs: Revenue from certification program fees including CAIMC, CPMB, CMCC, and CHA credentials. Programs range from free (Beta CMCC, CPMB) to paid tiers ($49-$600). Income is one-time per credential plus renewal fees.
2. Advanced Fellowship Programs: Revenue from specialized fellowship programs (FIMC-HCC, FGSC, FIPC, FNSC, FOSC, FOPC, FDMC, FAPMC, FOGC, FGUC, FGEC, FSNFC, FEMC, FHIM) with pricing from $140-$350. Fellowships include training, credential, and 3-year validity.
3. Medical Coding and Auditing Services: Fee-for-service revenue from providing medical coding auditing ($685/month per provider), HCC-risk adjustment coding services, end-to-end RCM services, surgery coding services, hospital coding services, and ICD-11 implementation services to healthcare providers.
4. Credential Renewal Fees: Credential renewal at $49 for 3-year extension, covering all PMBAUSA credentials held by a professional. Single renewal fee applies across all credentials.
5. Internship and Incubator Programs: Free medical coding internship through CodersGrade with optional internship certificate fee of $69 upon successful completion. Incubator program includes job placement assistance.

Pricing tiers

Go-to-market motion2 records

Distribution channels4 records

Marketing channels7 records

Core offering

PMBA USA is a medical coding and billing education and certification company that sells professional certifications (CMCC, CPMB, CAIMC, CHA, CMC), advanced specialty fellowships covering 15+ medical domains (HCC, inpatient, surgery, neurology, ophthalmology, dermatology, orthopaedics, OB-GYN, gastroenterology, anaesthesia, SNF, HIM), the CodersGrade internship program, and fee-for-service offerings including medical coding auditing, RCM, hospital coding, surgery coding, HCC risk adjustment, ICD-11 implementation, and AI medical coding software development.

Product overview

PMBA USA offers a comprehensive portfolio of medical coding and billing certifications, advanced fellowships, and professional services. The core offerings include five primary certifications: CMCC® (Certified Medical Coding Consultant), CPMB® (Certified Professional Medical Biller), CAIMC® (Certified AI Medical Coder), CHA™ (Certified HIPAA Administrator), and CMC® (ICD-11, SNOMED, LOINC, ATC). These are complemented by 13 specialty fellowships covering areas such as HCC coding, inpatient coding, surgery coding, neurology, ophthalmology, dermatology, orthopedics, OB-GYN, gastroenterology, anesthesia/pain management, skilled nursing facilities, and health information management. Service offerings include ICD-11 implementation services, hospital coding services, surgery coding services, HCC-risk adjustment coding services, end-to-end RCM services, medical coding auditing, and AI medical coding software development. The CodersGrade® internship program provides practical experience. All programs are delivered online and self-paced, designed exclusively for already-certified medical coders seeking specialty advancement.

Differentiator

Problem solved

Functional benefit

Brands

• CodersGrade®: Medical coding internship and incubator program providing hands-on training with 1000+ real-style medical records for certified coders seeking job-ready experience.

Products and services

• CMCC® (Certified Medical Coding Consultant) Advanced-level certification for experienced medical coders (5+ years) transitioning into leadership, audit, compliance, and consulting roles. Covers ICD-10-CM, CPT, HCPCS, ICD-10-PCS, DRG, APC, HIPAA compliance, risk adjustment, and NLP in medical coding.
• CPMB® (Certified Professional Medical Biller) Foundational certification program focused on revenue cycle management, claim submission accuracy, denial management, and payer compliance for medical billing professionals. Free training with optional certification exam at $199.
• CAIMC® (Certified AI Medical Coder) Industry's first comprehensive AI-integrated medical coding certification covering NLP-driven documentation analysis, GPT-4 fine-tuning, LLM applications, automation workflows, AI compliance accuracy, and hands-on training with John Snow Labs NLP and Amazon Comprehend. Priced at $150 (50% off from $300).
• CHA™ (Certified HIPAA Administrator) Advanced compliance-focused certification centered on HIPAA regulations, data privacy governance, security risk management, and healthcare regulatory frameworks. Administered through ecfirst.com. Priced at $600.
• CMC® (ICD-11, SNOMED, LOINC, ATC) Advanced global coding certification focused on modern classification systems covering ICD-11 post-coordination, SNOMED CT clinical terminology mapping, LOINC laboratory data standards, and ATC drug classification integration. 120-hour structured learning, priced at $99.
• Certificate Course in MACRA MIPS Compliance Advanced regulatory and value-based reimbursement certification for medical coders covering MIPS performance categories, quality reporting, and payment adjustments under MACRA.
• FIMC®-HCC (Fellowship in Integrated Medical Coding – HCC) Advanced fellowship focusing on Hierarchical Condition Category (HCC) coding, risk adjustment models, MEAT documentation validation, RADV audit preparation, and RAF score optimization for Medicare Advantage plans. Priced at $280 with 3-year credential validity.
• FGSC™ (Fellowship in General Surgery Coding) Advanced specialty fellowship covering general surgical procedure coding, operative documentation review, CPT surgical procedures, and compliance with global surgical package rules. Includes 300+ HIPAA-compliant redacted medical records and 15-day intensive training. Priced at $150.
• FIPC™ (Fellowship in Inpatient Coding) Advanced fellowship focused on inpatient DRG coding, hospital documentation compliance, MS-DRGs, principal diagnosis, MCC/CC coding, and complex inpatient case review methodologies. Priced at $155.
• FNSC™ (Fellowship in Neurology & Neurosurgery Coding) Advanced fellowship covering complex spinal and cranial procedure coding, CPT 61000–64999, craniotomy, spinal fusions, neuro-endovascular, stereotactic procedures, add-on logic, modifier precision, and global surgical compliance for neurosurgical settings. Priced at $150.
• FOPC™ (Fellowship in Ophthalmology Coding) Advanced specialty fellowship focused on eye visit coding, ophthalmic surgical reporting, diagnostic testing, global surgical package rules, bilateral procedure rules, and modifier compliance for ophthalmology practices. Priced at $140.
• FDMC™ (Fellowship in Dermatology Coding) Advanced specialty program focused on accurate CPT reporting, lesion and biopsy coding, E/M leveling, biopsy vs excision, Mohs surgery, modifier application, and documentation compliance for dermatology. Priced at $145.
• FOSC™ (Fellowship in Orthopaedic Coding) Advanced specialty program focused on fracture care billing, arthroscopy and joint replacement coding, modifier precision, and global surgical compliance for orthopaedic practices. Priced at $300.
• FOGC™ (Fellowship in Obstetrics & Gynecology Coding) Advanced specialty program focused on global maternity package billing, gynecologic surgical reporting, modifier precision, and documentation compliance for obstetrics and gynecology. Priced at $140.
• FGEC™ (Fellowship in Gastroenterology Coding) Advanced specialty program focused on endoscopic procedure reporting, colonoscopy billing rules, modifier accuracy, and documentation compliance for gastroenterology practices.
• FAPMC™ (Fellowship in Anaesthesia & Pain Management Coding) Advanced specialty program focused on anesthesia unit calculation, time reporting accuracy, physical status modifiers, qualifying circumstances, medical direction modifiers, CRNA/AA billing rules, and pain management injections. Priced at $150.
• FSNFC™ (Fellowship in Skilled Nursing Facility Coding) Advanced specialty program focused on PDPM methodology, HIPPS code calculation, MDS alignment, and Medicare Part A compliance for skilled nursing facilities.
• FHIM (Fellowship in Health Information Management) Comprehensive 2-month program covering health data management, compliance, patient information security, ICD-10, SNOMED CT, LOINC, HL7, and advanced technologies in healthcare for health information management professionals.
• FIMC (Fellowship in Medical Coding Training for Freshers) 3-month comprehensive online training program for beginners following the USA Medical Coding Curriculum aligned with AAPC CPC certification. Provides a pathway for entry-level coders to pursue certification.
• CodersGrade® (Medical Coding Internship) Medical coding internship and incubator program offering hands-on experience with 1,000+ real-style de-identified medical records, mentorship, job placement assistance, and career coaching for certified coders. Optional internship certificate available for $69.
• ICD-11 Training Program Comprehensive ICD-11 training program covering ICD-11 structure, post-coordination, SNOMED CT integration, LOINC, ATC, and digital health documentation for healthcare providers preparing for the global ICD-11 transition.
• Hospital Coding Services Comprehensive hospital coding services including MS-DRG assignment, principal diagnosis, MCC/CC coding, UB-04 form completion, and CMI optimization for hospitals and health systems.
• Surgery Coding Services Expert surgery coding services across multiple specialties including cardiology, dermatology, orthopedics, gastroenterology, neurosurgery, OB-GYN, ophthalmology, ENT, urology, and general surgery for healthcare providers.
• HCC-Risk Adjustment Coding Services Expert HCC-Risk Adjustment Coding services for Medicare Advantage plans focusing on accurate RAF score calculation, MEAT documentation validation, and risk adjustment compliance for healthcare organizations.
• End-to-End RCM Services Comprehensive revenue cycle management services including medical billing, claim submission, intensive accounts receivable follow-up, payment posting, and certified billing and coding team support for healthcare providers.
• Medical Coding Auditing Services Expert medical coding auditing services at $685 per month per provider to ensure OIG compliance, identify coding errors, upcoding/downcoding trend identification, and provide detailed audit reports and recommendations.
• ICD-11 Implementation Services ICD-10 to ICD-11 mapping services, ICD-11 medical records coding, dual coding support, staff training on ICD-11 structure, and SNOMED/LOINC integration for healthcare organizations transitioning to ICD-11.
• AI Medical Coding Software Development and Testing Services AI-driven medical coding software development using fine-tuned GPT-4, NLP for HCC risk adjustment coding, and rigorous third-party AI software testing services for healthcare providers building AI-assisted coding workflows.

Quantifiable outcome

• 87% job placement rate for graduates of PMBAUSA programs
• +4 more outcomes

Named customers3 records

Segments6 records

Ideal customer profiles4 records

Technology focussed Yes

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration6 records

AI capability7 records

Feature5 records

Partnerships

Four partnerships are on record, tiered core and minor.

• MEDESUN Medical Coding Academy / MEDESUN PRIMEcoreOthersMEDESUN Prime Medical Coding Academy is the parent entity and operational arm of PMBAUSA LLC, headquartered in Hyderabad, India. MEDESUN develops and reviews all curricula with a multidisciplinary team of physicians, AHIMA/AAPC-credentialed coders, and compliance experts. FIMC and fellowship trademarks are registered to MEDESUN PRIME. PMBAUSA LLC was established in 2009 and is now managed by Medesun Medical Coding Academy in India.
• ecfirst.comcoreChannel Partner/ Reseller/ Distributorecfirst.com is a leading provider of healthcare compliance solutions and the exclusive administrator of the CHA – Certified HIPAA Administrator certification. PMBAUSA LLC offers CHA certification to medical coders and billers as part of their credential ecosystem, with ecfirst.com handling program delivery, training curriculum, and certification examination.
• RazorpaycoreTechnology or IntegrationRazorpay is the primary payment gateway processing all transactions on pmbausa.com, handling credit cards, debit cards, UPI, and net banking. PMBAUSA does not store card, banking, or UPI details on their servers. Razorpay enables installment payment options for Indian students (e.g., ₹6,000–₹9,000 upfront with 2 installments).
• The CPD Certification Service (UK)minorStrategic or Co-development PartnerPMBAUSA LLC holds CPD (Continuing Professional Development) membership with The CPD Certification Service in the UK. This membership supports continuing professional development recognition for PMBAUSA's educational programs. Note: CPD membership does not represent government or regulatory accreditation.

Scale indicators7 records

Recent moves7 records

Expansion highlights5 records

Emerging players

• MedicalCodingCert.org / Certification Coaching Org: Smaller online medical coding certification prep providers offering CPC/CCS prep. Overlaps with PMBAUSA's training audience but with narrower scope and lower specialization depth.

Direct peers

• Libman Education: Libman Education sells online medical coding and HIM courses (including ICD-10/ICD-11 readiness) to already-credentialed professionals. Same target persona as PMBAUSA's fellowships and similar self-paced e-commerce delivery model.
• AHIMA (American Health Information Management Association): AHIMA issues CCS, CCS-P, RHIA and RHIT credentials and is the other anchor credentialing body for the US medical coding workforce PMBAUSA targets. Directly comparable as a credential issuer and continuing-education provider for HIM professionals.
• Coding Clarified: Coding Clarified is an online medical coding and auditing training and services provider for certified coders and billers. Comparable to PMBAUSA across the certification, fellowship, and outsourced coding services stack.
• CareerStep / Penn Foster Career School: Penn Foster (which acquired CareerStep) runs online medical coding and billing training programs with similar self-paced, certification-track structure. Comparable in training product shape and pricing tier to PMBAUSA's certification lineup.
• AAPC (American Academy of Professional Coders): AAPC is the dominant US medical coding certification body issuing CPC, COC, CIC, CRC and related credentials — the de facto hiring standard PMBAUSA's certified-coder audience already holds. It is the most direct peer in medical-coding certification and training.

Broad incumbents

• HealthStream: HealthStream is a broad healthcare workforce training and credentialing platform serving hospitals and health systems. Overlaps with PMBAUSA's enterprise-services audience (medical coding, compliance, RCM training) at much larger scale.
• Optum (UnitedHealth Group) – RCM Services: Optum is a large incumbent RCM and coding services provider to hospitals, payers, and physician groups. Directly comparable to PMBAUSA's RCM, HCC, hospital, and surgery coding services line, but at vastly greater scale.

Others

• ecfirst (Compliance Training): ecfirst administers PMBAUSA's CHA – Certified HIPAA Administrator certification. Adjacent to PMBAUSA through a reseller/partner relationship and overlapping healthcare compliance training audience.
• MEDESUN Medical Coding Academy: Operational parent entity of PMBAUSA LLC, managing curriculum development and India operations from Hyderabad. Not a competitor but a tightly coupled entity whose strategic posture directly shapes PMBAUSA's roadmap.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

• Facebookfacebook.com/profile.php
• LinkedInlinkedin.com/company/professional-medical-billers-association-usa

Compliance4 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles2 records

Subsidiaries1 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 Professional Medical Billers Association USA