We are building an AI-native, HIPAA- and HITRUST-compliant Revenue Cycle Intelligence platform designed to fundamentally modernize how healthcare organizations manage claims, payments, and revenue recovery. Built as a modular, agentic system, our platform ingests data from EHRs, practice management systems, and clearinghouses through a secure integration gateway, normalizes it into a canonical schema, and then orchestrates a sequence of specialized intelligence agents across intake, eligibility, documentation understanding, coding, claim quality, submission, payments, denials, and appeals. Each agent is deterministic where compliance demands it, LLM-assisted where human-level reasoning creates value, and fully auditable through an enterprise audit trail and human-in-the-loop framework. The platform proactively prevents denials, optimizes charge and claim accuracy, automates high-confidence workflows, and elevates complex decisions—such as appeals and payer disputes—into explainable, branded, and learning-driven processes, delivering faster cash flow, higher recovery rates, and a dramatically lower operational burden for providers. ABOUT THIS ROLE Platform runs on a set of interconnected services — APIs, background workers, database layers, caching systems, and audit infrastructure — that process claims, orchestrate agents, and deliver results to providers. The Backend Engineer owns the implementation of this infrastructure layer, working closely with the Platform Architect on design and with the AI Engineer to wire agent outputs into persistent, queryable data. This is a senior individual contributor role. You will not be a support resource, you will own full features independently. We need someone who can execute without constant direction. If you thrive in environments where you have real ownership, real impact, and real latitude, this is the right role. WHAT YOU WILL OWN • FastAPI service development — building the API endpoints that the frontend, agents, and external integrations consume, including authentication, authorization, and request validation • PostgreSQL schema implementation — translating the canonical data model into production-grade database tables, indexes, constraints, and migration scripts (Alembic) • Enterprise Audit Trail System (EATS) — implementing the immutable, compliance-grade audit log that captures every agent action, human decision, configuration change, and system event with full traceability • Background job infrastructure — Celery worker configuration, task queue design, retry logic, dead-letter handling, and job monitoring for asynchronous claim processing workflows • Redis caching layer — cache strategy design, TTL management, and cache invalidation patterns for agent outputs, eligibility results, and payer rule lookups • Agent output persistence — building the data layer that receives structured outputs from LangGraph agents and stores them in the canonical schema with proper lineage and versioning • Human-in-the-Loop (HITL) data layer — the database and API layer that surfaces agent-escalated decisions to human reviewers, captures their decisions, and feeds them back into agent learning loops • Provider and organization management — multi-tenant data access patterns, organization provisioning APIs, and user management services • Reporting and analytics APIs — the query layer that powers claims dashboards, denial metrics, revenue analytics, and agent performance reporting in the frontend • Integration with MIG outputs — consuming normalized data from the Healthcare Integration Engineer's pipeline and persisting it correctly into the canonical schema WHAT WE'RE LOOKING FOR • 5+ years of backend engineering experience, with at least 2 years as a senior engineer • Deep Python expertise — FastAPI, SQLAlchemy, Alembic, Pydantic, Celery • PostgreSQL proficiency — complex schema design, query optimization, indexing strategy, and migration management • Experience building production APIs — RESTful design, authentication/authorization patterns, API versioning, and error handling • Redis and async processing — you have built background job systems that actually work reliably in production • Strong data modeling instincts — you can translate complex business requirements into clean, queryable database schemas • Experience working in regulated or compliance-sensitive environments — you understand why audit trails and data integrity matter • Ability to work independently — in a 4-person team, you will not have a tech lead reviewing every decision. You need the judgment to make good calls and flag when you are uncertain NICE TO HAVE • HIPAA technical implementation experience • Experience working with LangChain or LangGraph — understanding how agent outputs are structured helps with data layer design • Healthcare domain familiarity — claims, RCM, billing workflows • Experience with observability tooling — Datadog, Sentry, OpenTelemetry • GraphQL API experience for complex query scenarios WHY THIS ROLE You will build the operational backbone of a platform that processes millions of dollars in healthcare claims. Your work i.e. the APIs, the audit trail, the data layer is what makes the platform reliable, auditable, and enterprise-ready.