Senior Founding Engineer, Platform

Alpaca Health • New York, NY

57d

About The Position

Alpaca Health is the operating system for autism care. We help clinicians start, run, and scale their own practices — handling the operational complexity that gets in the way of care so they can focus on kids.

The incumbents in this space are genuinely terrible. Clinicians are running their businesses on spreadsheets, outdated EHRs, and duct tape. We replace all of that: billing, payroll, scheduling, clinical documentation, parent communication — one platform, built right, from the ground up.

It's working. We went from zero to $2M in revenue in 8 months, closed a $10M Series A, and we're growing 30% month over month — serving hundreds of autistic children across hundreds of clinics. Every week, more clinicians choose Alpaca to build their practice on. The platform needs to mature to match that growth — and that's where you come in.

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.

The decisions made in the next year — how the domain model is structured, how state machines are enforced, how AI workflows are built safely — will define the system for a long time. You'd be joining after product-market fit but before the platform has fully caught up to the business. Not "rescue a failing system." Build the foundation that lets a working, fast-growing system scale correctly.

Founding engineer autonomy, real ownership, and a company that's clearly on its way somewhere.

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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed