Full Stack Software Engineer

Alpaca Health•New York, NY

1d•Onsite

About The Position

Alpaca Health enables clinicians to become entrepreneurs, starting in autism care. We help clinicians launch and scale their own clinics by providing AI-powered software, payer contracting, and full back-office infrastructure. Our goal is simple: shift power in healthcare away from large consolidated entities and back to clinicians. We've raised over $14M in funding from early-stage investors like Core Innovation Capital, Adverb Ventures, and South Park Commons, and are building for long-term category leadership. More importantly, we're serving hundreds of patients, while growing 30% MoM. This role is full-time. We’re looking for candidates based in NYC or open to relocating who are open to 5 days a week in the office. We're a tiny engineering team building something large. You'd be the person who owns the platform foundation — the data models, the money logic, the state machines, the API contracts, the AI infrastructure. Not "owns" in the sense of reviewing PRs. Owns in the sense of: you designed it, you built it, you stand behind it. One day you're designing a schema migration strategy. The next you're building an LLM pipeline for clinical documentation. The day after that you're debugging a billing edge case that only appears when Colorado Medicaid is the secondary payer. This isn't a job for someone who wants to specialize. It's a job for someone who gets uncomfortable when critical business logic lives in someone's head instead of in code.

Requirements

You've spent 4+ years somewhere correctness actually mattered — fintech, insurance, healthcare, logistics. You've felt what it's like when business rules are implicit, when the data model doesn't match reality, when someone hot-patches production because the migration wasn't thought through. You don't want to build that system.
You think in state machines before you write code. You'd rather ship right than ship fast. You're senior enough to make hard technical calls but you still want to be the one making them in code, not in meetings.

Nice To Haves

Bonus if you've shipped LLM features in production (RAG, evals, guardrails), worked with event sourcing or ledger architectures, or have healthcare/EHR experience.

Responsibilities

The core domain model. Patients, providers, credentials, authorizations, sessions, claims, payments. You design how Alpaca represents these things — and how they evolve without breaking what's already in production.
Money invariants. The rules governing how money moves — rate calculations, payout conditions, payroll logic — live in code, not Notion docs. You make them testable and enforceable.
Lifecycle state machines. Patients, claims, authorizations, credentials — each has explicit states and valid transitions. The system physically cannot enter impossible states.
Schema evolution. Migrations run before features ship. Nothing breaks when the model changes.
AI infrastructure. We're already shipping LLM-powered clinical workflows. You build the foundation that makes them reliable, auditable, and safe in a healthcare context.
Security and HIPAA. Access controls, audit logging, encryption. You own the technical posture for a platform handling PHI.
Production. Deploy it, monitor it, and pick up the phone when it breaks at 2am.