Senior Fullstack Engineer - RCM

flaglerhealth; United States; Hybrid; USD 150,000 - 190,000; Full time

Job summary

Flagler Health is building a clinical operating system for modern musculoskeletal care, delivering tools that connect patient acquisition, clinical workflows, and ongoing engagement.

A distributed remote team operates with hybrid offices in NYC and Vancouver. Senior full-stack engineers work across the entire monorepo using Vue 3, TypeScript, Express, MongoDB, and shared TS packages to ship features end-to-end.

Qualifications

• 5+ years building and shipping production web apps, including 3+ years in health care revenue cycle experience.
• Strong TypeScript across the stack.
• Hands-on experience with modern front-end framework (Vue or React).
• Backend experience with Node, Express, and MongoDB/Mongoose.
• Knowledge of query costs, indexing, and schema decisions for large data.

Responsibilities

• Build screens against the internal component library.
• Design and implement API routes contract-first with shared schemas.
• Model clinical and revenue cycle data in MongoDB, keeping it queryable as data grows.
• Work inside shared TypeScript packages used across the repo.
• Take features from spec to production and support them post-launch.
• Work across the full revenue cycle, from pre-visit clearance to payment.
• Integrate with EHRs and external systems clients run on.

Skills

TypeScript

Vue/React

Node.js

MongoDB

Healthcare rev cycle

API design

Mentoring

Tools

Express

MongoDB/Mongoose

Turborepo/Nx

Job description

Flagler Health is building the clinical operating system for modern musculoskeletal care.

We partner with MSK provider groups and specialty clinics to help them grow, operate more efficiently, and deliver better longitudinal care across patient acquisition, clinical workflows, and ongoing patient engagement.

Our platform sits at the intersection of care delivery and clinic operations, helping providers capture more value across the full patient lifecycle.

We've recently raised our Series B and are entering our next phase of growth.

Senior Fullstack Engineers own our main product surface end to end. One monorepo, one product: Vue 3 and TypeScript on the front, Express and MongoDB behind it, and a stack of shared TypeScript packages in between.

You will move across all of it rather than sit on one side.

Most of the hard problems here aren't algorithmic. Clinical data is never clean, the same patient spelled three ways, a date that means something different in every system it passes through. And the people behind the data are people: they reschedule, they don't pick up, they tell the front desk what they never told their doctor. We're looking for engineers who find that interesting rather than annoying, and who'd rather model the mess than pretend it away.

The work is contract-first. API schemas are declared once and both frontend and backend typecheck against them, so a broken endpoint is a build failure instead of a bug report. If you've spent years keeping a hand-written client in sync with a backend that kept moving, this will feel like a relief.

What You'll Do:

• Build screens against our internal component library
• Design and implement API routes contract-first, with schemas shared across frontend and backend
• Model clinical and revenue cycle data in MongoDB, and keep it queryable as collections grow
• Work inside shared TypeScript packages every app in the repo depends on
• Take features from spec to production and support them once they're live
• Work across the full revenue cycle, from pre-visit clearance through payment
• Integrate with the EHRs and external systems that our clients already run on

Required Qualifications:

• 5+ years building and shipping production web applications, including 3+ years of health care revenue cycle management experience
• Strong TypeScript across the stack
• Hands-on experience with modern front-end framework such as Vue or React
• Backend experience with Node, Express, and MongoDB/Mongoose
• You know what your queries cost. Patient, clinical, and financial data gets large and wide fast, and the difference between a query that scales and one that falls over is usually an index or a schema decision made months earlier
• You can name the shortcomings of the tools you use, not just their features
• You've designed for growth you couldn't fully predict, and can explain what you'd do differently now
• You've worked in a large codebase you didn't write and improved it rather than rewriting it
• Experience moving health data between systems: HL7, FHIR, EHR connectivity
• You've built complex yet auditable systems geared towards visibility
• Experience processing financial events while effectively managing states for each transaction
• You've created configurable state machines and rule engines that can be easily tweaked to handle new cases with minimal code changes and long term maintenance

Preferred Qualifications:

• Understanding of how care is delivered: clinical workflow, care pathways, how a patient moves through the system, and how a practice gets paid for it
• Familiarity with the OpenAI API or similar LLM tooling
• Monorepo experience (e.g., Turborepo, Nx)
• Realtime or streaming applications
• Durable workflow orchestration (e.g., Temporal, Cadence, AWS Step Functions)
• Experience with cloud platforms such as AWS, Azure, or GCP
• Experience building analytics or reporting on top of transactional data
• Experience with EDI/X12 (270, 271, 835) is a plus

Work Environment:

Distributed remote team with hybrid offices in NYC and Vancouver.

Hybrid. Regular and consistent on-site presence is required for this position.

Our Values:

• Owner: We own our work like founders.
• Builder: We like making things from scratch. We don't need a playbook to start, and we'd rather ship a rough first version than wait on a perfect spec.
• Fast: We make quick decisions. We favor progress and respect process.
• Transparent: We communicate directly. We value merit and honesty, and we challenge assumptions, including our own.
• Curious: We explore new approaches and ask "why" often.