Staff Software Engineer - Full-Stack, Founding Team

• Spec-driven development is the method. We turn problems into structured specs, decompose specs into vertical slices, and drive implementation from there. Specs are the source of truth that both humans and agents build against.
• Agentic tools are the default. Claude Code or equivalent is how code gets written here, not an accessory. You should already write the majority of your code this way and have a personal workflow you can articulate and teach.
• You own what ships, even when an agent wrote it. Speed comes from leverage plus judgment: thorough testing, real code review, and a high bar for what reaches production.
• We work problems, not tickets. Engineers sit close to our users - the revenue cycle teams themselves - watch how the work actually happens, and reason from first principles about what to build.

The stack: TypeScript and Python on Azure, with Databricks as the data platform. You don’t need deep experience in all of it - you need the fundamentals to come up to speed fast and the judgment to use it well.

Do you have experience in Tooling?, * 7+ years building and shipping production full-stack software

• Deep fundamentals: system design, testing discipline, and the code-review judgment to evaluate large volumes of generated code
• Agentic coding tools are already your default - you can show your workflow and explain how it makes you measurably faster
• A builder’s disposition toward ambiguity: you’d rather define the problem and own the outcome than execute a spec someone else wrote

Nice-to-haves:

• Healthcare, RCM, or EDI experience (835/837 transactions, payer workflows, denial management)
• Hands-on Azure and/or Databricks experience
• Experience with data-intensive systems - pipelines, large-scale file ingestion, event-driven processing

2.22.2 out of 5 stars United States Remote $150,000 - $300,000 a year - Full-time, Pulled from the full job description

• Health insurance
• Paid time off
• Vision insurance
• Health savings account
• Dental insurance
• Flexible spending account
• Paid holidays, Base salary of $150,000-$300,000 depending on experience and scope, plus bonus and eligibility for a long-term incentive opportunity we’ll discuss during the process. Annuity Health offers its employees excellent benefits including: Health, Dental, Vision, HSA and FSA Accounts, Voluntary Insurance, Paid Holidays, PTO, and 401(k).

Healthcare revenue cycle management is a massive industry that still runs on phone calls, portals, and spreadsheets. We’re a profitable, established RCM company building our technology platform from line zero: new product, new codebase, and a small but mighty founding team. The goal is a simpler, smarter revenue cycle, with benefits providers can actually measure.

This is zero-to-one build at a profitable company. Your first users are in the building - our own revenue cycle teams, doing this work at scale today, sitting on operational data most startups would spend five years trying to acquire. Feedback loops are measured in hours, not quarters.

Why this role exists

Most companies our size bolt technology onto an existing operation. We’re doing the opposite: standing up a founding engineering team with a mandate to build the platform that becomes the core of the business. There is no legacy codebase to inherit, no existing engineering culture to navigate, and no roadmap committee. The patterns you set - technical and cultural - are the ones the company scales on.

What you’ll do

• Build a greenfield platform end to end - data pipelines, services, and product surfaces - and put it in the hands of the teams running revenue cycle work every day
• Build agent-driven workflows and automation that take real work off those teams’ plates, plus the analytics that show exactly where provider revenue is going and why
• Build safe automation at scale, with the evals to prove it. Automation that touches provider revenue has to be measurably reliable, not just good in a demo
• Turn ambiguous, high-value operational problems into working software
• Write the specs, patterns, and agent context that make the whole team faster, not just yourself
• Help interview the next wave of engineers and shape how this team works
• Work directly with the CTO; the distance between you and company-level decisions is one conversation