Staff Software Engineer, Accounts & Ledgering

Company: Confidential - Growth-stage healthcare AI company
Location: Hybrid in Mountain View, San Francisco, Los Angeles or New York City
Compensation: $210,000 - $275,000 + competitive equity
Employment Type: Full-time
Visa Sponsorship: Visa transfers (OPT, H-1B transfer)

About the Company

A growth-stage healthcare technology company whose AI suite spans clinical documentation, provider copilots, coding and revenue cycle management, used by hundreds of thousands of clinicians.

The Role

Our client is hiring a Staff Software Engineer (8+ years backend, 3+ years building financial systems from 0 to 1) who has built a double-entry payment ledger and has deep expertise in accounts and ledgering: payments, billing, reconciliation, ledgers or accounting. You will own the full architecture of money-critical systems at scale, with immutable, event-oriented data models where correctness is non-negotiable.

What You Will Do

• Design and operate a double-entry payment ledger and the next-generation account and ledger model, with invariants that make it structurally impossible to "print money".
• Own the full money path: insurance ledger, posting and adjustment engines, patient account ledgers, bank reconciliation and AR reporting.
• Reconcile billed charges, payer remittances, bank deposits and financial reports, and surface discrepancies before customers do.
• Scale idempotent, explainable posting pipelines using negation/reversal semantics.
• Operate money-critical systems on very large Postgres tables with safe migrations, projections, backfills and incident response.
• Set the bar for observability and operational readiness, and mentor senior and staff engineers.

What You Bring

• 8+ years building backend systems, including 3+ years designing and operating financial systems from 0 to 1
• Hands-on experience building a double-entry payment ledger
• Deep expertise in payments, billing, reconciliation, ledgers or accounting
• Immutable, event-oriented data modeling where correctness is non-negotiable
• Strong Python, PostgreSQL and SQL

Nice to Have

• Healthcare revenue cycle, insurance remittance (835/ERA) or bank reconciliation experience

Tech Stack

Python, PostgreSQL, event-driven architecture, SQL, REST APIs, distributed tracing, CDC, bank APIs, BAI2, OCR