Full Stack Software Engineer

Alpaca Health; New York (NY); On-site; USD 100,000 - 140,000; Full time

Job summary

Alpaca Health, located in New York City, is searching for a Full Stack Software Engineer who can take charge of the platform foundation, encompassing data models and AI infrastructure. This full-time position requires a candidate with at least 4 years of experience in correctness-focused roles, preferably in fintech or healthcare. Key responsibilities include designing lifecycle state machines, ensuring financial rules are correctly implemented in the code, and maintaining security standards. Join a company poised for growth and leave a significant structural impact.

Qualifications

• 4+ years of experience in a relevant field where correctness mattered.
• Ability to think in state machines and prioritize shipping right over fast.
• Experience shipping LLM features in production is a plus.

Responsibilities

• Own the core domain model and ensure it evolves without breaking production.
• Design and implement money invariants and lifecycle state machines.
• Build the AI infrastructure robustly for clinical workflows.
• Handle security and HIPAA compliance including access controls and encryption.
• Deploy and monitor applications, ready to debug issues as they arise.

Skills

State machine thinking

Correctness in software engineering

Experience in fintech/healthcare/logistics

AI infrastructure

Job description

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: 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.

Role: Full Stack 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

• 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.

Who You Are

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.

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

Why Join Now

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.