Client background
Surgical Partners is a Sydney-based technology company that builds SaaS software for managing the accounting, billing, and financial administration of medical practices across Australia. Their platform addresses one of the most complex problems in healthcare administration: the multi-party billing environment unique to medicine, where charges flow between patients, private health insurers, Medicare, and practice administrators simultaneously, each with their own rules, schedules, and compliance requirements.
By the time they engaged Squash Apps, Surgical Partners had established a growing customer base of surgical practices and was entering a phase of rapid product expansion. Their core platform was in production and earning strong NPS scores from existing clients. The CTO, Timo A., had a clear product vision and a capable in-house team — but a significant product roadmap backlog that the existing team size couldn't address at the pace the business needed.
The decision to use staff augmentation rather than direct hiring was deliberate and strategic. Timo had led engineering teams before and understood that the right augmentation model — one with engineers who felt like genuine team members rather than contractors — could deliver senior talent at a speed and cost structure that wouldn't be possible through the Sydney hiring market.
The challenge
Surgical Partners faced the dual challenge common to well-executing SaaS companies: product-market fit proven, but the roadmap that would compound growth was perpetually delayed. The in-house engineering team was competent and committed, but the team was sized for maintenance and incremental iteration, not for the kind of multi-track feature development that would move the product into new market segments.
Specific to the Surgical Partners context, medical practice accounting software has unusual complexity. The Australian healthcare billing environment is governed by multiple regulatory frameworks — the Medical Benefits Schedule (MBS), private health insurer fee schedules, and GST rules specific to medical services — that change regularly and require ongoing software maintenance simply to remain compliant. This compliance maintenance work competed directly with new feature development, and the small in-house team was constantly making difficult prioritisation trade-offs.
There was also a testing and quality assurance gap. The existing automated test coverage was thin — reasonable for a product that had grown quickly, but insufficient for a platform handling real money flows for hundreds of practices. A bug in a billing calculation or a missed edge case in an insurance claim submission was not just an inconvenience; it was a potential financial and regulatory issue for the practices depending on the software. The CTO wanted to significantly improve test coverage as part of expanding the team.
How we engaged
The engagement was structured as a dedicated pod working within Surgical Partners' existing development process. Squash Apps provided two to four engineers — the number fluctuated based on sprint priorities — who were fully integrated into the team's Azure DevOps workflow, attended all sprint ceremonies, and were accountable to the same definition of done as the in-house engineers.
Critically, the Squash Apps PM worked closely with Surgical Partners' local Product Manager rather than operating as a separate layer of management. Sprint planning, backlog grooming, and sprint reviews were joint activities. There was no separate "offshore track" or "offshore backlog" — all engineers drew from the same prioritised backlog, and all work was visible in the same Azure DevOps board.
This integration model was something Timo had specifically requested based on past experiences with offshore vendors who had created separate silos. The Squash Apps engineers were introduced to the Surgical Partners team in a kick-off video call, were given access to all relevant systems and documentation from day one, and established direct working relationships with their in-house counterparts. When scope changes or technical questions arose mid-sprint — as they inevitably do in SaaS development — engineers on both teams communicated directly rather than routing everything through project managers.
Even when the engagement involved in-person visits to Sydney — which happened twice during the year — the Squash Apps team's culture and working style held up in person the same way it did remotely, which was something Timo specifically noted in his Clutch review.
What we built
Over the engagement period, the team delivered a substantial expansion of the platform's capabilities. The primary workstreams were API development, application testing, and web development — but within those categories the work spanned a wide range of complexity.
On the API development side, the team built several new integration endpoints connecting the Surgical Partners platform to external health insurer claim processing systems. These integrations required careful handling of the idiosyncratic data formats used by different insurers, robust error handling for claim rejection scenarios, and comprehensive logging for audit purposes. The team also built a new billing rules engine that allowed practice administrators to configure custom fee rules without requiring a code deployment — significantly reducing the support burden on the Surgical Partners team for practice-specific billing configurations.
The application testing workstream was one of the most impactful contributions. The Squash Apps QA engineer systematically built out test coverage for the billing and claims processing modules — the highest-risk areas of the platform. Test coverage in those modules grew from approximately 30% to over 80% during the engagement, and the automated regression suite became a standard part of the deployment gate. The reduction in production bugs attributable to this coverage improvement was measurable and significant.
Web development work included a redesigned practice dashboard, new reporting screens for practice administrators, and a series of UX improvements driven by customer feedback that had been sitting in the backlog. The team shipped consistently on a two-week sprint cadence, meeting 100% of sprint commitments across all delivery milestones.
Technical approach
The Surgical Partners platform is a web application built on modern JavaScript/TypeScript standards, with Azure as the cloud infrastructure provider. Azure DevOps was used throughout for version control, CI/CD pipelines, sprint tracking, and test management. The team leveraged Azure's PaaS services including Azure SQL Database, Azure Functions for background processing, and Azure Service Bus for the asynchronous communication patterns required by the multi-step insurance claim workflows.
The billing rules engine introduced during the engagement was one of the more technically interesting deliverables. Rather than encoding billing rules as code that required developer intervention to change, we built a configuration-driven system where practice administrators could define fee schedules, insurance-specific rules, and claim routing logic through an admin interface. The rules were stored as structured JSON and evaluated at runtime by a rules interpreter, giving the product team significantly more flexibility to support practice-specific configurations without engineering involvement.
Test infrastructure improvements included the implementation of contract testing between the platform and its external insurer integrations, using a consumer-driven contract testing approach. This meant that when an insurer changed their API format, the contract tests would catch the breaking change before it reached production — eliminating a class of integration failures that had previously been difficult to detect until a claim submission failed.
Results
The most direct measure of success was sprint delivery: 100% of committed sprint milestones were delivered across the full engagement period. This is a standard Timo cites specifically in his Clutch review, and it reflects the core value the engagement delivered: reliable, predictable development capacity that the business could depend on when making product and commercial commitments.
From a product standpoint, the platform shipped more features and improvements in the twelve months of the engagement than it had in the preceding eighteen months combined. The new billing rules engine reduced practice-specific support tickets by approximately 40%, freeing up both engineering and customer success time. The expanded test coverage reduced production incidents significantly and gave the team the confidence to deploy more frequently.
Timo's assessment in his Clutch review captures the less quantifiable but equally important dimension: "The management style of Squash Apps is very positive, the communication is very direct and open, the team members are always engaged and happy. In an in-person meet we were able to see an excellent team culture in action — from the top to the individuals." In staff augmentation, culture fit is as important as technical skill, and this engagement demonstrated that it is possible to achieve genuine cultural integration between teams working across different continents.
For HealthTech and MedTech SaaS companies seeking to scale their engineering capacity without compromising on quality or reliability, the Surgical Partners engagement provides a proven model: a dedicated pod integrated into existing processes, delivering consistent sprint commitments, building test coverage alongside features, and maintaining the cultural cohesion that makes long-term software partnerships successful. The $200,000+ engagement value reflects not a single project but an ongoing relationship built on repeated, demonstrated delivery.