Senior (Principal) EHR Integration Engineer (Remote - US only)

Quadrivia

7d•Remote

About The Position

Quadrivia is seeking a Senior (Principal) EHR Integration Engineer to design, build, and operate the integration layer connecting the Quadrivia AI platform to the U.S. healthcare ecosystem. This role involves moving clinical data into AI agents and writing AI-generated outputs back into systems of record within a compliant, HIPAA-governed environment. It is a hands-on technical role at the intersection of healthcare standards and distributed systems, directly impacting customer onboarding speed and data trust. The integration lead will also coordinate multiple parallel integrations, set standards, and ensure consistent delivery across ad-hoc teams. This role is crucial for the success of every customer deployment, determining how quickly new health systems can be onboarded and how reliably the AI can be used with patient data. The engineer will be responsible for the reliability, accuracy, and integrity of all data flows, working closely with security and compliance teams. They will also support customer due-diligence and security reviews, plan capacity, and sequence go-lives. As a technical authority on interoperability, the engineer will mentor other engineers and collaborate with various internal teams to map clinical workflows into integration contracts. Writing clean, test-driven code and owning AI-generated code contributions are also key aspects of this position.

Requirements

10+ years in software/integration engineering, with deep, demonstrated expertise building HL7v2 and FHIR integrations in production healthcare environments (including ancillary flows such as imaging/DICOM, scheduling, and ePrescribing/Surescripts).
Experience coordinating multiple engineers or parallel workstreams across concurrent customers — comfortable keeping standards and delivery consistent in a fluid, demand-driven team structure.
Must be based in the USA and authorized to work in the U.S. without sponsorship.
Availability to travel within the USA as needed for customer onboarding, go-lives, and on-site integration work.
Hands-on experience with at least one major EHR's interface/API surface (Epic, Oracle Health/Cerner, athenahealth, or MEDITECH) — ideally including a vendor certification or marketplace go-live.
Production experience with InterSystems IRIS (our integration platform; Ensemble/HealthShare also relevant) — or a comparable engine (Mirth/NextGen Connect, Rhapsody, Cloverleaf) with the ability to ramp on IRIS quickly.
Strong programming skills in Python (and comfort with JavaScript/TypeScript or Java/Groovy for engine scripting).
Solid understanding of healthcare data: clinical terminologies (LOINC, SNOMED CT, ICD-10, CPT, RxNorm), patient matching, and EHR data models.
Working knowledge of integration connectivity and security: MLLP, SFTP, REST, OAuth2/SMART, TLS/mTLS.
Extensive experience working in a highly compliant environment under HIPAA/HITECH, SOC 2, and HITRUST controls.
Reliability mindset: observability, idempotency, retries, reconciliation, and graceful degradation.
Excellent communicator — clear, structured, concise (S.T.A.R / S.A.R or similar).
Culture fit: kind, exceptionally smart, mission-driven, field expert.

Nice To Haves

Experience with national interoperability networks: TEFCA/QHINs, Carequality, CommonWell, eHealth Exchange, or state/regional HIEs.
Familiarity with Da Vinci, Argonaut, and US Core implementation guides, and CMS Interoperability & Prior Authorization rules.
Cloud & DevOps literacy: GCP, Kubernetes, Docker, Terraform; event-driven architectures (queues/streams).
Exposure to AI, RAG, or LLM workflows feeding/consuming EHR data.
RHIA, CHPS, or equivalent health-informatics credential.

Responsibilities

Design and build resilient, bidirectional integrations with major EHRs (Epic, Oracle Health/Cerner, athenahealth, MEDITECH, TruBridge/CPSI, Veradigm/Allscripts, eClinicalWorks, NextGen).
Implement and maintain HL7v2 interfaces (ADT, ORU, ORM, SIU, MDM, DFT) and FHIR R4 / US Core integrations, including SMART on FHIR and Bulk FHIR.
Build and operate integration pipelines on InterSystems IRIS (our integration platform) — and, where needed, via aggregators like Redox, Health Gorilla, or 1upHealth.
Handle C-CDA documents, X12 transactions (270/271 eligibility, 837/835 claims), and the connectivity layer (MLLP, SFTP, TLS, VPN, OAuth2 client credentials).
Navigate EHR vendor programs end-to-end: Epic (Showroom/App Orchard, Bridges, Interconnect), Oracle Health CODE, athenahealth Marketplace — including registration, security review, and go-live.
Own reliability of the integration estate: monitoring, message reconciliation, replay/backfill, dead-letter handling, and clear fallback behavior when an interface or downstream EHR is degraded.
Guarantee accuracy, patient-matching integrity, and de-identification/PHI handling across every data flow; partner with Security and Compliance on audits.
Support customer and partner due-diligence and security reviews (questionnaires, BAAs, technical assessments) to quickly unblock access to production data and keep integrations on schedule.
Coordinate multiple parallel, demand-driven integration teams — assigning work, reviewing designs, unblocking engineers, and keeping standards and timelines consistent across concurrent customer integrations.
Plan capacity and sequence go-lives across the integration portfolio as ad-hoc teams spin up and down with demand.
Set integration standards and mentor engineers; act as the organization's technical authority on interoperability.
Collaborate closely with Backend, AI, Clinical, and Implementation teams to map clinical workflows into integration contracts.
Write clean, test-driven, maintainable code; validate and own all AI-generated code contributions.