Staff Full Stack Engineer - Ruby, Python, React - HealthTech - NYC

A profitable, AI-native health tech platform is rebuilding how its providers get paid, and needs one engineer to own it. You'd be the technical lead on a brand-new billing product, sitting next to the CTO and co-founder, writing code most days and hiring the team around you.If you've built claims, remits or denials systems and thought \"I'd do this completely differently from scratch\", this is that chance. $205K–$235K base, NYC hybrid.The companyAn AI-native, certified EHR and practice-management platform built for healthcare providers. It is venture-backed, and has been profitable for more than half its life.Billing is now a strategic bet, not a feature. They're standing up a dedicated billing and revenue cycle group: an Engineering Manager, two Product Managers (billing and payments, revenue cycle) and this role as its technical anchor.Company name shared once you're interested and we've had a first chat.The roleStaff Full Stack Engineer and Tech Lead for the new billing initiative. You own the architecture for how providers get paid, end to end.This is a player-coach seat. You'll still be shipping code weekly, while making the architecture calls and building out a billing and RCM engineering team around you. Not a pure architect, not a pure manager.You'll work directly with the CTO and co-founder, so you need to be comfortable with founder-level ownership and pace, without leaning on big-company process.What you'll doOwn the architecture of the new billing platform: services, data models, GraphQL APIs and the React/TypeScript front end, inside a mature Ruby on Rails codebaseDesign the core financial workflows (claims, remittances, eligibility, denials, payment posting) so money lands correctly and every cent is traceableWrite production code most weeks, and set the bar for correctness, testing and observability in money-moving systemsRun design reviews, mentor engineers and shape how the team uses AI dev tools day to dayHelp hire and grow a billing and RCM engineering team from the first few seatsPartner with Product, Design and the CTO on what gets built and in what order