Senior Fullstack Software Engineer Jobs in San Francisco, CA

About Alpaca Health

Alpaca Health enables clinicians to become entrepreneurs, starting in autism care.

We help clinicians launch and scale their own clinics by providing AI-powered software, payer contracting, and full back-office infrastructure. Our goal is simple: use technology to make business ownership possible for every passionate provider.

We've raised over $14M in funding from early-stage investors like Core Innovation Capital, Adverb Ventures, and South Park Commons, and are building for long-term category leadership. More importantly, we're serving hundreds of patients, while growing 30% MoM.

This role is full-time. We’re looking for candidates based in New York City or San Francisco, excited about a 5 days in-office culture.

Both founders are technical. Every engineer on the team has experience at early-stage startups. Several have built products from zero to scale, and one previously founded a YC-backed company.

We care deeply about engineering quality, ownership, and building systems that correctly model reality. We do not have layers of management, architecture committees, or roadmap bureaucracy. Engineers talk directly to customers, make technical decisions, and ship.

Role: Senior Software Engineer

We're a tiny engineering team building something large. You'd be the person who owns the platform foundation — the data models, the money logic, the state machines, the API contracts, the AI infrastructure. Not "owns" in the sense of reviewing PRs. Owns in the sense of: you designed it, you built it, you stand behind it.

One day you're designing a schema migration strategy. The next you're building an LLM pipeline for clinical documentation. The day after that you're debugging a billing edge case that only appears when Colorado Medicaid is the secondary payer.

This isn't a job for someone who wants to specialize. It's a job for someone who gets uncomfortable when critical business logic lives in someone's head instead of in code.

What You’ll Own

AI-Native Clinical Workflows

We're rethinking healthcare software from the ground up with AI built into the core experience. You'll help build products that assist with clinical documentation, treatment planning, reassessments, supervision, and administrative work, giving providers more time to focus on patient care.

Revenue & Payments Infrastructure

Healthcare is ultimately a complex flow of money. You'll own systems that determine how services are authorized, billed, adjudicated, and paid, ensuring providers get paid accurately and on time while maintaining trust in the platform.

Provider Business Operations

Starting a healthcare practice today is painfully manual. Build the tools that make credentialing, contracting, compliance, payroll, scheduling, and staffing feel effortless, allowing clinicians to focus on growing their practices instead of managing paperwork.

Patient & Family Experiences

Design the products families interact with throughout their care journey, from intake and onboarding to scheduling, communication, progress tracking, and payments. You'll help create experiences that make accessing care dramatically easier.

Internal Automation Systems

Much of healthcare still runs on spreadsheets, inboxes, and manual workflows. You'll build software and AI systems that automate operational work across credentialing, billing, authorizations, and care coordination, enabling a small team to support thousands of providers.

Platform Foundations

You'll also own the underlying systems that make all of this possible: data models, APIs, security, compliance, reliability, AI infrastructure, and production systems. We expect engineers to own products end-to-end, from the database schema all the way to the user experience.

Who You Are

• You've built in environments where mistakes matter. Whether in fintech, healthcare, insurance, logistics, or another operationally complex domain, you've worked on systems where data integrity, money movement, and business rules couldn't be treated as an afterthought.

• You think in systems, not features. When someone describes a workflow, you naturally start modeling states, transitions, invariants, and edge cases. You enjoy turning messy real-world processes into clean software abstractions.

• You have strong product instincts. You care about the user experience as much as the implementation. You can sit with a provider, understand their pain points, and translate them into software that feels simple despite complex underlying logic.

• You thrive in ambiguity. You don't need a fully written PRD to get started. You're comfortable taking a loosely defined problem, identifying the important questions, proposing solutions, and driving execution.

• You operate with high ownership. You don't think of your job as writing tickets. You think of your job as making a problem disappear. If something is blocking the business, you'll figure out how to solve it regardless of where it falls on the org chart.

• You are AI-native. You actively use AI in your day-to-day workflow and are constantly experimenting with new ways to increase leverage. You're excited about what software development, operations, and healthcare workflows look like when AI is a first-class primitive rather than an add-on.

• You balance speed with judgment. You know when to move fast and when to invest in foundations. You can build quickly without leaving behind a trail of technical debt that someone else has to clean up later.

• You enjoy learning complicated domains. Healthcare is full of exceptions, regulations, payer rules, credentialing requirements, and operational edge cases. Rather than finding that frustrating, you find it intellectually interesting.

• You still love writing code. You're experienced enough to lead major technical decisions, but you haven't lost the desire to build. You want to spend your time creating products and systems, not managing process.

Nice to Have

• Experience building AI-powered products in production

• Experience with LLM workflows, agents, evals, or developer tooling

• Experience modeling complex operational or financial systems

• Healthcare, EHR, insurance, or revenue cycle experience

• Experience at an early-stage startup where you owned large parts of the product

Why Join Now

The decisions made in the next year — how the domain model is structured, how state machines are enforced, how AI workflows are built safely — will define the system for a long time. You'd be joining after product-market fit but before the platform has fully caught up to the business. Not "rescue a failing system." Build the foundation that lets a working, fast-growing system scale correctly.

Founding engineer autonomy, real ownership, and a company that's clearly on its way somewhere.

Compensation Range: $120K - $200K