Founding Software Engineer

Artificer Health - Remote (US hours overlap required)

Why this role exists

Prior authorization kills people. Not in a metaphorical, boardroom-deck kind of way. In a "patient didn't get their medication approved in time" kind of way. The process exists to create friction, and it does its job well - practices spend 13 to 16 hours a week on paperwork that should take minutes, and somewhere in that pile of faxes and phone calls, patients fall through.

We're building Artificer Health to end that. The platform we're building touches every part of the prior auth workflow: connecting into EHR systems, extracting the right clinical data, formatting and submitting auth requests to payers, tracking status, and closing the loop back into the clinic's workflow. It is not glamorous infrastructure. It is critical infrastructure. When it works, a clinician submits a request in two clicks and gets back to caring for patients. When it doesn't, someone waits longer than they should for care they already need.

This engineer is the one who builds it. Not the first version of it - the real version. The one that handles edge cases from actual payers with actual quirks. The one that holds up when a practice is submitting thirty auths on a Monday morning. The one that an audit trail can be pulled from two years from now when someone asks what happened with that submission.

This is a founding seat. You will not inherit a working system. You will not inherit a tech stack. You will not inherit an architecture decision log. You will start from the decisions that have been made so far and then make the rest of them - knowing that you will live with the consequences, and so will patients.

What you'll actually do

Build the core platform. EHR integrations starting with athenahealth, prior auth submission workflows, payer connectivity, data pipelines. The things that make the product function at all.

Own integrations end-to-end. That means you understand the athenahealth API well enough to know what it does wrong, you know where X12 278 transactions get weird, and when a payer's portal doesn't respond the way it's supposed to, you've got an opinion on what to do about it.

Make the system observable. Silent failures are unacceptable here. A failed auth submission that no one catches is a patient not getting care. You will build logging, alerting, and auditing that make failures loud and traceable.

Work directly with clinical feedback. The Forward Deployed Engineer is in the clinics. The Support and Success Engineer is hearing about every broken edge case. That feedback routes to you, and you build from it. There is no wall to throw code over.

Build for compliance from the start. This is PHI. HIPAA applies now. SOC 2 Type 2 and HITRUST are on the roadmap and you'll be a reason we get there or don't. Security isn't a sprint at the end - it's in the schema design, the access controls, the logging, and the way you think about every new surface you expose.

Make pragmatic technology calls. Pick tools that solve the problem at a small team's scale. Maintainability over novelty. If something you built six months ago is wrong for where we are now, kill it and build the right thing.

Work with the AI Wrangler to integrate intelligent automation into the workflow. The intelligence layer only matters if the plumbing underneath it is solid.

What you bring

You have built production systems that handle sensitive data and you take that responsibility seriously. Not because you're told to, but because you know what it means when something goes wrong.

You are comfortable - or can get comfortable fast - with healthcare data standards. FHIR, HL7, X12. You don't need to be an expert walking in the door. You need to be the kind of person who reads the spec, finds the edge case the spec didn't cover, and figures out what to do about it.

You have strong instincts about system reliability. You think about what happens when the network call fails, when the payer portal times out, when the EHR sends malformed data. You build for those cases before they happen.

You are full-stack or backend-heavy with enough frontend range to own a feature completely. You don't hand off your API to someone else to wire up. You finish what you start.

You have a bias toward shipping. You can hold complexity in your head without letting it become an excuse to over-engineer or under-deliver. When something is good enough to learn from, you send it.

You ask hard questions about decisions that have already been made, including your own. If something you built last month is wrong, you say so and fix it.

You are curious about how systems actually work - not just the ones you build, but the ones you're building against. If savoring a new patio11 essay about the hidden machinery of billing infrastructure sounds like a good Saturday afternoon, you'll fit in here.

You can work with US business hours overlap. The team is remote and intends to stay lean. Communication has to be clear because there is no one standing next to you to explain what was meant.

What we bring

A problem that matters and a team that is serious about solving it. You will not be building features that optimize ad revenue or make an onboarding flow 4% smoother. You will be building something that directly affects whether patients get access to care.

Full ownership. Your name is on the architecture. Your judgment is trusted. There is no committee approving your approach or a platform team you have to wait on.

Honesty about where we are. We are pre-revenue. We are recruiting pilot customers. The athenahealth integration is being built. If that is exciting rather than alarming, you are in the right place.

Compensation that reflects founding-team risk and responsibility - equity meaningful enough to matter, salary that is fair for what you're taking on. We will talk through the specifics directly.

How to apply

Send an email to [email protected].

Subject line: Founding Software Engineer.

Write two things: what you've built that is most relevant to this role, and what part of this problem you'd want to tackle first. Skip the cover letter format. Talk to us like a person.