Senior Fullstack Engineer

NYC Office · Remotecontract

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Remote

senior

$190k–$250k

H1B: no

Flagler Health Senior Fullstack Engineer at Flagler Health owns the main product surface end to end using Vue 3, TypeScript, Express, and MongoDB. The role involves building screens, designing API routes contract-first, modeling clinical and revenue cycle data, and integrating with EHRs and external systems.

Responsibilities

Most of the hard problems here aren't algorithmic. Clinical data is never clean, the same patient spelled three ways, a date that means something different in every system it passes through. And the people behind the data are people: they reschedule, they don't pick up, they tell the front desk what they never told their doctor. We're looking for engineers who find that interesting rather than annoying, and who'd rather model the mess than pretend it away.
The work is contract-first. API schemas are declared once and both frontend and backend typecheck against them, so a broken endpoint is a build failure instead of a bug report. If you've spent years keeping a hand-written client in sync with a backend that kept moving, this will feel like a relief.
Build screens against our internal component library
Design and implement API routes contract-first, with schemas shared across frontend and backend
Model clinical and revenue cycle data in MongoDB, and keep it queryable as collections grow
Work inside shared TypeScript packages every app in the repo depends on
Take features from spec to production and support them once they're live
Work across the full revenue cycle, from pre-visit clearance through payment
Integrate with the EHRs and external systems that our clients already run on

Qualification

Strong TypeScript across the stackBackend experience with NodeYou know what your queries costUnderstanding of how care is deliveredMonorepo experience (eRealtime or streaming applicationsDurable workflow orchestration (eExperience with EDI/X12 (270

Required

5+ years building and shipping production web applications, including 3+ years of health care revenue cycle management experience
Strong TypeScript across the stack
Hands-on experience with modern front-end framework such as Vue or React
Backend experience with Node, Express, and MongoDB/Mongoose
You know what your queries cost. Patient, clinical, and financial data gets large and wide fast, and the difference between a query that scales and one that falls over is usually an index or a schema decision made months earlier
You can name the shortcomings of the tools you use, not just their features
You've designed for growth you couldn't fully predict, and can explain what you'd do differently now
You've worked in a large codebase you didn't write and improved it rather than rewriting it
Experience moving health data between systems: HL7, FHIR, EHR connectivity
You've built complex yet auditable systems geared towards visibility
Experience processing financial events while effectively managing states for each transaction
You’ve created configurable state machines and rule engines that can be easily tweaked to handle new cases with minimal code changes and long term maintenance

Preferred

Understanding of how care is delivered: clinical workflow, care pathways, how a patient moves through the system, and how a practice gets paid for it
Familiarity with the OpenAI API or similar LLM tooling
Monorepo experience (e.g., Turborepo, Nx)
Realtime or streaming applications
Durable workflow orchestration (e.g., Temporal, Cadence, AWS Step Functions)
Experience with cloud platforms such as AWS, Azure, or GCP
Experience building analytics or reporting on top of transactional data
Experience with EDI/X12 (270, 271, 835) is a plus

Company

Flagler Health

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Source: ashby

Active within the past hour

Remote-friendly

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