Senior Software Engineer

Alpaca Health • New York City, NY

39d • 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

• 4+ years of experience in a field where correctness is critical (e.g., fintech, insurance, healthcare, logistics).
• Experience with implicit business rules, data models not matching reality, or production hot-patches due to migration issues.
• Ability to think in state machines before writing code.
• Preference for shipping correctly over shipping fast.
• Senior enough to make hard technical calls and implement them in code, not just in meetings.

Nice To Haves

• Shipped LLM features in production (RAG, evals, guardrails).
• Experience with event sourcing or ledger architectures.
• Healthcare or EHR experience.

Responsibilities

• Design and build the core domain model, including patients, providers, credentials, authorizations, sessions, claims, and payments, ensuring evolution without breaking production.
• Implement and enforce money invariants, including rate calculations, payout conditions, and payroll logic, making them testable and enforceable in code.
• Develop lifecycle state machines for patients, claims, and authorizations to prevent impossible states.
• Manage schema evolution and migrations to ensure features ship without breaking when the model changes.
• Build the foundation for AI-powered clinical workflows, ensuring reliability, auditability, and safety in a healthcare context.
• Own the technical posture for security and HIPAA compliance, including access controls, audit logging, and encryption for PHI.
• Deploy, monitor, and maintain the production system, responding to critical issues as needed.

What This Job Offers

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