Senior Backend Software Engineer

📌 ABOUT ALPACA HEALTH 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: use technology to make business ownership possible for every passionate provider. 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 New York City or San Francisco, excited about a 5 days in-office culture. Both founders are technical. Every engineer on the team has experience at early-stage startups. Several have built products from zero to scale, and one previously founded a YC-backed company. We care deeply about engineering quality, ownership, and building systems that correctly model reality. We do not have layers of management, architecture committees, or roadmap bureaucracy. Engineers talk directly to customers, make technical decisions, and ship. 🎯 ROLE: SENIOR BACKEND SOFTWARE ENGINEER 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. 🚧 WHAT YOU’LL OWN Core Platform Integrations Healthcare runs on a fragmented ecosystem of vendors, clearinghouses, and systems. You'll build and maintain critical integrations with platforms like Candid, Silna, Availity, HubSpot, payroll providers, and state Medicaid systems, ensuring data flows reliably across the entire Alpaca platform. Revenue & Operations Infrastructure Own the backend systems that power billing, authorizations, eligibility, patient responsibility, payroll, and provider payouts. You'll design the engines that move millions of dollars through the platform while ensuring accuracy, auditability, and trust. Internal Systems & Automation Much of healthcare operations still happens through spreadsheets, PDFs, inboxes, and manual processes. You'll build software and AI-powered workflows that automate credentialing, authorizations, billing operations, compliance, and care coordination, allowing a small team to support thousands of providers. Data & Reporting Platform Build the data infrastructure that powers reporting across the company. You'll own the pipelines, models, and backend services that give providers visibility into their businesses and enable internal teams to make operational decisions with confidence. Payroll & Workforce Systems Design the systems that power provider compensation, payroll integrations, time tracking, PTO, and workforce operations. You'll help make getting paid feel seamless for clinicians while ensuring compliance and financial accuracy behind the scenes. Platform Foundations You'll also own the underlying systems that make everything possible: APIs, data models, event-driven architectures, security, compliance, reliability, and AI infrastructure. We expect engineers to think deeply about system design and build products that remain correct as Alpaca scales from hundreds to thousands of providers. 🧠 WHO YOU ARE - You've built in environments where mistakes matter. Whether in fintech, healthcare, insurance, logistics, or another oper…