Senior Software Engineer at ExactRx in Remote

We're fixing one of the most broken and costly parts of the US healthcare system: medical billing.

Healthcare providers spend over $250B each year on administrative overhead just to get paid by insurance. Billing is expensive because it's hard: 100x harder than processing a credit card payment, with rules that differ for every insurance company. Most of it still runs on teams of people tracking those rules by hand, with little or no software to help. We're rethinking medical billing from the ground up, with AI agents and data science that automate this complexity so providers get paid faster and for far less. Our agents log into the systems our customers already use, then code, prepare, and submit their insurance claims, and we're accountable for getting them paid. We focus on surgery, the most expensive specialty to bill for.

We're backed by Overline, Tech Square Ventures, and Northwestern Medicine + incredible doctors that sit on the boards of the groups we sell to. We've all had a claim denied or watched someone we love fight one. We're helping our customers expand access to care by removing financial barriers, and we're excited to learn more about you!

ABOUT THE ROLE

As our Senior Software Engineer, you'll build the systems that move a claim from a provider's EHR to the payer: the integrations, the claims platform, and the tools our delivery team uses every day. You'll report to our CTO and work daily with our AI and service delivery teams.

This role is forward deployed. You'll own each customer deployment from technical discovery through go-live, and you'll have room to grow into an engineering lead role as the team scales. You'll be our first engineering hire outside our leadership team, so we need a self-starter who sets priorities, makes decisions, and ships without waiting for direction.

WHAT YOU'LL DO

• Build and maintain EHR integrations with systems such as SIS, eClinicalWorks, Cerner, and Veradigm over SFTP, HL7, FHIR, and browser automation, shipping each one inside the window the EHR vendor sets.
• Build the automation that lets our AI agents work inside customers' EMRs as credentialed users, together with our Applied AI Engineer.
• Build the services and data pipelines that turn encounter data into clean 837 claims and process 835 remittances.
• Lead customer deployments end to end, from discovery and workflow scoping through integration testing and go-live, and turn each one into reusable integration patterns.
• Build the frontend for our delivery team's work queues and the reports customers use to track results.
• Keep production reliable: monitoring, on-call, and HIPAA-compliant infrastructure, alongside our CTO.

WHAT WE'RE LOOKING FOR

• 5+ years shipping production web applications across backend, frontend, and data pipelines.
• Strong Ruby or Python knowledge along with experience with frontend frameworks like React.
• Experience with working with SQL and optimizing queries.
• Experience with configuring cloud services on providers such as GCP or AWS.
• Comfort working with PHI under HIPAA controls and talking through technical tradeoffs with customer engineers and operators.
• Hands-on experience building with LLM APIs such as Anthropic or OpenAI, including prompting, structured outputs, tool use, and basic evaluation.
• Daily use of AI coding tools such as Claude Code or Cursor, with the judgment to review and test what they produce.
• Experience leading projects or mentoring other engineers.
• Nice to have: HL7, FHIR, X12, or EHR vendor experience, healthcare claims (837 and 835), forward deployed or customer engineering experience, and early-stage startup experience.

Exactrx is an equal opportunity employer. We don't discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other protected characteristic. If you need accommodation during the application process, let us know. Background checks are administered in accordance with applicable law.