Commure

Staff Software Engineer, Accounts & Ledgering

Mountain View, CA · Staff+

Sponsorship not specifiedDetected 1 day ago

PythonPostgreSQLNLPIncident ResponseAccountingValuationAR/VRPatient CareLeadershipCommunicationCollaborationMentoring

About the role

This is the path from "insurance paid us" to "the books balance, the patient knows what they owe, and leadership can trust the numbers."
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.

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"
Own complex, cross-system initiatives end to end: architecture and design, implementation, migration, rollout, and everything that comes with running it in production.
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.
8+ years building software, with a track record of Staff-level work, architecture ownership, mentoring, cross-team influence

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
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
Strong backend engineering (Python preferred) and deep experience with relational databases at scale: query performance, ACID transactions, safe migrations, data integrity

Today, 500,000+ clinicians across 500+ healthcare organizations nationwide trust Commure to handle $25B+ in annual claims and support over 200 million patient interactions.

Healthcare RCM, patient accounting, insurance remittance (835/ERA), AR aging, or practice-management billing

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.
Reconcile three (or four) sources of truth: billed charges, payer remittances, bank deposits, and financial reports. Surface discrepancies before customers do
You can work with ops and customers when correctness matters

This listing is sourced directly from Commure's careers page and normalized into a canonical job model.