Staff Software Engineer, Accounts & Ledgering

About Commure

At Commure, we're building the AI Operating System for healthcare, the foundation that defines how care is delivered, documented, and financed. Our platform spans the full care journey: Ambient AI and Dictation eliminating documentation burden at the point of care, intelligent Agents automating patient and revenue workflows, and autonomous RCM processing billions in claims, all on a single AI-native platform integrated with 60+ EHRs.

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, moving toward an event-oriented financial model where every charge, payment, adjustment, and refund is immutable, balances are derived from history, and reporting is integrated by design.

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, and OCR'd deposit slips to verify dollars.
• Reporting ledger and AR: procedure-level rollups, point-in-time views, AR aging, collections reports, plus drift detection.
• An emerging unified event stream as the backbone of a cleaner, replayable ledger architecture.

Responsibilities

• Design the next-generation account and ledger model with immutable events, derived balances, and invariants that enforce financial correctness.
• Keep operational balances and financial reports in lockstep; develop drift detection and self-healing mechanisms.
• Reconcile multiple sources of truth: billed charges, payer remittances, bank deposits, and financial reports.
• Scale idempotent, explainable posting and adjustment pipelines across high transaction volumes using negation/reversal semantics.
• Operate money-critical systems on large Postgres tables, ensuring safe migrations, trigger-driven projections, backfills, observability, and incident response.
• Set the bar for observability and operational readiness (monitoring, logging, distributed tracing, dashboards, alerting, SLOs, and safe production rollouts).
• Partner with platform and product teams to protect sensitive customer data and uphold regulatory and compliance standards.
• Own complex, cross-system initiatives end to end: architecture, design, implementation, migration, and production operations.
• Mentor Senior and Staff engineers, lead architecture and design reviews, and establish high engineering standards.

Qualifications

Minimum Qualifications

• 8+ years of software engineering experience with a track record of Staff-level work, architecture ownership, mentoring, and cross-team influence.
• Strong backend engineering skills and deep experience with relational databases at scale (query performance, ACID transactions, safe migrations, data integrity).
• Experience designing or operating financial systems, payments, billing, reconciliation, accounting, or ledgers (double-entry accounting, append-only ledgers, idempotency, reversals, derived balances).
• Proven experience shipping production systems with strong observability, alerting, and incident response practices for high-stakes workflows.
• Strong communication and collaboration skills.

Preferred Qualifications

• Experience with Python.
• Background in healthcare RCM, patient accounting, insurance remittance (835/ERA), AR aging, or practice-management billing.
• Experience with 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 models.