Central Valley — Healthcare Practice Bookkeeping

Bookkeeping, built by a PharmD who sat on your side of the desk.

Keen Ledger works with solo and small healthcare practices across California's Central Valley — dentists, physical therapists, chiropractors, veterinarians, behavioral health. The kind of practice where the owner knows something is off in the books but can't get a straight answer about what.

Founder Andrew Keenan, PharmD
Experience 25 years in healthcare · 16 as a business owner
Certification QuickBooks ProAdvisor
The question that never quite goes away

You got into healthcare to take care of patients, not to wonder every month whether your practice actually made money.

The gap

Most bookkeepers never worked a day inside a healthcare business.

So they build your books the way they build everyone else's. A generic template. Five expense categories. A P&L that technically balances and practically tells you nothing you can act on.

The work gets done. It just doesn't get done in a way that helps you run the practice. You can't tell at a glance what you're spending on supplies versus what insurance is actually paying you. Your reimbursements are lumped into a single revenue line. Tax season becomes a two-week scramble, your CPA bills you extra to clean up the mess, and in the back of your head there's the same question that never quite goes away.

That gap — between a bookkeeper who's technically competent and one who actually understands how a healthcare business operates — is the reason most practice owners never fully trust their own numbers.

Why Keen Ledger is different

Operator instinct you can't get from someone who's never owned the business.

I'm a PharmD. I spent sixteen years in the pharmacy business — a staffing service I co-founded in 2001 and grew from zero to $2.5M in annual revenue, and an independent compounding pharmacy I owned from 2007 to 2017, which I took from $1.5M to over $5M before selling my stake.

I know what it feels like to stare at a set of books that won't answer the one question you actually need answered. I know what a reimbursement trend looks like before anyone in the industry has talked about it. I know the difference between a business that's healthy and one that's quietly deteriorating, because I've operated both.

I build the books the way I wish mine had been built. A chart of accounts designed around how your practice actually operates. Reconciled to the penny every month. A monthly P&L you can read in two minutes and act on the same day.

What I do, and what I don't

A clear scope, held carefully.

What I do
  • Monthly transaction categorization
  • Account reconciliation to the penny
  • Custom chart of accounts, built around your practice
  • Monthly P&L delivery with clear segmentation
  • Accounts receivable & accounts payable management (as add-ons)
  • 1099 filing in January (as an add-on)
  • Email-based communication with clear response windows
What I don't do
  • Payroll processing (I'll refer you to Gusto or ADP)
  • Tax preparation or filing (that's your CPA)
  • Receipt management — I'll help train your office manager instead
  • CFO, advisory, or forecasting work
  • Third-party POS integrations with QuickBooks
  • Restaurants, car dealerships, or cash-heavy retail
Andrew Keenan
About Andrew

Twenty-five years as a healthcare operator. Now applied to your books.

PharmD from the University of the Pacific. Former manager at Rite Aid who spotted the California pharmacist shortage in 2001 and co-founded a staffing service to address it. Owned an independent compounding pharmacy for a decade, specializing in non-sterile compounding — bioidentical hormone replacement, pain creams, troches, pediatric and veterinary formulations.

Exited the pharmacy on my own terms in 2017 when PBM reimbursement pressure made it clear the model was being structurally dismantled. I've worked as a clinical pharmacist for the State of California since.

Keen Ledger is the current application of a skill I've been building for a long time: identifying what the numbers are actually telling a healthcare business owner, and making sure those owners never have to guess about the health of their own practice.

PharmD, University of the Pacific QuickBooks ProAdvisor Veteran-owned LinkedIn
A 30-minute conversation

A Books Review, not a sales call.

A working diagnosis of what your current books are — and aren't — telling you. No pitch, no obligation, no follow-up sequence. If we're a fit, we'll talk about next steps. If we're not, you'll leave with a clearer read on your own numbers.

Schedule the Review

30 minutes · No cost · No obligation