60 Monograph Engineers Jobs Hiring Near You

About the Role

We're hiring a Staff Software Engineer to own the accounts and ledgering spine of our RCM platform. This is the path from “insurance paid us” to “the books balance, the patient knows what they owe, and leadership can trust the numbers.”

The team is designing and building the next generation of our account and ledgering system. We're moving toward an event-oriented financial model where every charge, payment, adjustment, and refund is immutable. Balances get derived from history rather than maintained by hand. Reporting should fall out of the design, not be stitched together afterward.

Your team owns the full money path:

• The insurance ledger append-only entries recording payer payments, contractual adjustments, denials, and patient responsibility buckets per procedure, with reversal/refund chains for corrections
• Posting and adjustment engines that turn remittances into ledger entries and automatically write off, rebucket, or transfer amounts to patient responsibility based on customer rules
• Patient account ledgers tracking balance, payments, credits, and refunds that drive statements, the patient portal, and collections
• Bank reconciliation — matching insurer checks to actual bank deposits (via bank APIs, BAI2 files, OCR'd deposit slips) so we only post against verified dollars
• Reporting ledger and AR — procedure-level rollups, point-in-time views, AR aging, collections reports, plus drift detection when operational balances disagree with reports
• An emerging unified event stream that will become the backbone of a cleaner, replayable ledger architecture

What You’ll Do

• Design the next-generation account and ledger model, immutable events, derived balances, clear semantics around payer balance vs. patient balance vs. adjustments vs. cash, with invariants that make it structurally impossible to “print money”
• Keep operational balances and financial reports in lockstep. Posting, adjustments, patient balances, rollups, and balance reports need to agree. When they don't, we need drift detection and self-healing
• Reconcile three (or four) sources of truth: billed charges, payer remittances, bank deposits, and financial reports. Surface discrepancies before customers do
• Scale idempotent, explainable posting and adjustment pipelines across high transaction volumes using negation/reversal semantics instead of mutable edits
• Operate money-critical systems on very large Postgres tables, safe migrations, trigger-driven projections, backfills, observability, and incident response where “eventually consistent” isn't acceptable
• Set the bar for observability and operational readiness (monitoring, logging, distributed tracing, dashboards, alerting, SLOs, and safe production rollouts) and make sure the team actually lives by it.
• Work hand-in-hand with platform and product teams to keep sensitive customer data protected, tighten security boundaries, and stay on top of our regulatory and compliance obligations.
• Own complex, cross-system initiatives end to end: architecture and design, implementation, migration, rollout, and everything that comes with running it in production.
• Make pragmatic calls that weigh security, correctness, reliability, performance, and simplicity against how fast we need to ship.
• Mentor Senior and Staff engineers, run architecture and design reviews, and push the technical bar higher through clear direction, strong engineering habits, and honest feedback.
• Take real ownership in a fast-moving environment. Spot systemic risks early and fix the root cause instead of patching around it.

What You Have

• 8+ years building software, with a track record of Staff-level work, architecture ownership, mentoring, cross-team influence
• Strong backend engineering (Python preferred) and deep experience with relational databases at scale: query performance, ACID transactions, safe migrations, data integrity
• Real experience designing or operating financial systems, payments, billing, reconciliation, accounting, or ledgers. You get double-entry accounting, append-only ledgers, idempotency, reversals, and why balances need to be derived from immutable history
• You've shipped production systems with observability, alerting, and incident response practices, especially for high-stakes workflows
• Strong communication and collaboration skills. You can work with ops and customers when correctness matters

Bonus points if you have

• Healthcare RCM, patient accounting, insurance remittance (835/ERA), AR aging, or practice-management billing
• File-based integrations, bank reconciliation, event-sourced/CDC architectures, or high-throughput batch pipelines
• Experience evolving a monolith toward clearer domain boundaries or event-oriented model