How a Growing LTC Pharmacy Scaled to 87 Billing Specialists Without Adding US Headcount
A seven-year talent infrastructure partnership
By the numbers
Specialists deployed today
87, across 8 billing functions
Functions built from zero
4, with no client-side staff
Steady-state load per specialist
15+ facilities
Partnership tenure
7 years
Time to independent production
60 days, managing 7–8 facilities
Talent geographies
Ukraine, Colombia, South Africa, Portugal
Time to full ramp
3–4 months, managing 10+ facilities
Team retention
[Many specialists at 3+ years, multiple at 5–6 years]
What this partnership is — and what itisn't
This is not an RCM engagement. Pharmbills did not redesign the client's billing process, did not own AR outcomes, and did not take over financial reporting. The client runs its own billing operation.
What Pharmbills delivers is the talent infrastructure that operation runs on — recruited, trained, managed, and retained on the Pharmbills side, providing services directly for the client every day. The result is a billing organization that scales faster, costs less, and turns over less than it would if the client were building it through the US labor market.
For LTC pharmacies in active growth and acquisition mode, that distinction matters.
Process redesign happens once. Talent infrastructure has to keep producing every month.
What Pharmbills delivers is the talent infrastructure that operation runs on — recruited, trained, managed, and retained on the Pharmbills side, providing services directly for the client every day. The result is a billing organization that scales faster, costs less, and turns over less than it would if the client were building it through the US labor market.
For LTC pharmacies in active growth and acquisition mode, that distinction matters.
Process redesign happens once. Talent infrastructure has to keep producing every month.
The situation in 2019
This LTC pharmacy was scaling faster than its US-based hiring pipeline could support. Every new pharmacy acquisition created a billing volume spike weeks before the next class of trained specialists was ready to absorb it. Internal hiring couldn't keep up — not because the client wasn't trying, but because the US healthcare billing labor market is structurally tight, expensive, and slow.
The leadership team had to choose between slowing the acquisition pipeline, accepting steady degradation in billing performance, or building capacity a different way.
They chose the third option.
The leadership team had to choose between slowing the acquisition pipeline, accepting steady degradation in billing performance, or building capacity a different way.
They chose the third option.
How the partnership works
01
Pharmbills sources, starts cooperation, and trains — fast
Pharmbills runs an active recruiting pipeline across Ukraine, Colombia, South Africa, and Portugal — markets with deep university-educated talent pools, strong English fluency, and significant time-zone overlap with US business hours. Specialists are pre-screened for healthcare aptitude and English proficiency before they ever reach a client interview.
From client approval to a deployed, ramping specialist is a matter of weeks, not the four-to-six-month cycle a typical US healthcare hire requires from posting to productive contribution.
From client approval to a deployed, ramping specialist is a matter of weeks, not the four-to-six-month cycle a typical US healthcare hire requires from posting to productive contribution.
02
Specialists provide services directly for the client
Every Pharmbills specialist on this account provides services under the client's processes, the client's systems, the client's quality standards, and the client's day-to-day priorities. They are functionally part of the client's billing organization. Pharmbills administers and manages all aspects related to its specialists, including compensation processing, operational support, administrative services, and service coordination, ensuring these functions remain entirely outside the client’s scope.
03
Training built for ramp velocity
LTC pharmacy billing is not something a new specialist learns by watching. They need working command of Part A versus Part D logic, per diem versus FFS billing, cycle fill reconciliation, hospice carve-outs, resident liability, and state-specific Medicaid rules before they touch a live case.
Pharmbills built its own training curriculum for this account rather than waiting on client-supplied documentation. The output:
Pharmbills built its own training curriculum for this account rather than waiting on client-supplied documentation. The output:
- Pharmbills specialists reach independent production in 60 days, managing 7–8 facilities
- By month 3–4 they exceed 10 facilities; in steady state they manage 15+
- The client's own internal onboarding takes 3–4 months to reach independent production at 4–5 facilities
That gap compounds at scale. Every new pharmacy acquisition is absorbed without a multi-quarter hiring lag on the billing side.
04
A management layer the client doesn't have to manage
Eighty-seven specialists is not a team that runs itself. Pharmbills built an internal management structure of captains and senior specialists overseeing the team across all eight functions. Client-side managers interact with this layer — not with individual billers.
When the client needs an ad hoc analysis, a custom report, or extra capacity on a special project, the Pharmbills team is the first call. The answer comes back accurate and on time, without the client having to redirect anyone on their own roster.
When the client needs an ad hoc analysis, a custom report, or extra capacity on a special project, the Pharmbills team is the first call. The answer comes back accurate and on time, without the client having to redirect anyone on their own roster.
Where the cost and efficiency gains come from
Pharmbills doesn't reduce the client's billing costs by reengineering their process. It reduces them by changing the underlying labor economics — and by stabilizing the team that runs the process.
- Specialist cost is meaningfully below the fully-loaded cost of comparable US-based billing roles. The savings are not marginal.
- Time to deployed capacity is measured in weeks, not months. For a client absorbing new pharmacies regularly, that pacing is the difference between integration that goes smoothly and integration that creates an AR backlog.
- Retention on this account significantly exceeds industry norms for billing and AR roles, where US turnover frequently runs 25–35% annually. Stable teams produce fewer errors, require less retraining, and build the institutional knowledge that makes a complex multi-state, multi-payer billing operation actually work.
- Client management overhead is lower because Pharmbills runs the management layer, not the client. The client manages a relationship with a structured organization, not an 87-person roster.
Add those four together and the client's billing operation runs more efficiently than it would if it were built entirely on the US labor market — at materially lower cost, with materially less internal management drag.
Scaling with the client through acquisition
The LTC pharmacy industry is consolidating. This client is actively acquiring pharmacies in new states, integrating them under a single brand. Every acquisition means new facilities, new payer relationships, new state-specific compliance, and a step-change in billing volume.
Pharmbills scales alongside the acquisition pipeline. The recruiting infrastructure, the training curriculum, and the management layer were all built to expand without breaking. The 87-person team today is not the team it was a year ago, and it will not be the team it is a year from now.
For an LTC pharmacy in active growth mode, that scaling capacity is often the operational constraint that determines how fast the company can absorb its own M&A. Solving it on the talent side rather than the process side keeps the client in control of every decision that touches their billing operation.
Pharmbills scales alongside the acquisition pipeline. The recruiting infrastructure, the training curriculum, and the management layer were all built to expand without breaking. The 87-person team today is not the team it was a year ago, and it will not be the team it is a year from now.
For an LTC pharmacy in active growth mode, that scaling capacity is often the operational constraint that determines how fast the company can absorb its own M&A. Solving it on the talent side rather than the process side keeps the client in control of every decision that touches their billing operation.
Where this stands today
87 specialists across 8 billing functions, up from a single small team in 2019
4 functions operated entirely by Pharmbills, with no client-side personnel
Specialists managing 15+ facilities each in steady state
Many team members on the account for 3+ years, with multiple specialists at 5- and 6-year tenure
New facilities absorbed into the billing workflow on a regular monthly cadence as the client acquires
The takeaway for LTC pharmacies in growth mode
Billing capacity is not something a growing LTC pharmacy can hire for fast enough through the US market. It is a talent infrastructure decision — and the right partner makes it possible to scale the AR engine at the same pace as the acquisition pipeline.
This case study describes what one such partnership looked like, seven years in.
This case study describes what one such partnership looked like, seven years in.
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Brandon Bolnick
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