Senior (Principal) EHR Integration Engineer (Remote - US only)

At Quadrivia, we have brought together some of the smartest and most passionate people in the sector to work on an ambitious goal: help make healthcare accessible and affordable for everyone on earth, by solving the chronic imbalance between the growing demand for medical care and the constrained supply of clinical skills. While externally we are starting with creating the world's most comprehensive and customizable clinical assistant to deliver routine tasks for clinicians, internally we are pioneering a new way to run a company.

Healthcare Interoperability & Clinical Data Infrastructure — USA-based

You will design, build, and operate the integration layer that connects the Quadrivia AI platform to the U.S. healthcare ecosystem — EHRs, practice-management systems, labs, HIEs, and national interoperability networks. This means moving clinical data into our AI agents (context, history, orders) and writing AI-generated outputs back into the systems of record, safely and within a highly compliant, HIPAA-governed environment.

This is a deeply hands-on, technical role at the boundary between healthcare standards and modern distributed systems. The integrations you own are the front door to every customer deployment — they directly determine how fast we can onboard a new health system and how much our AI can be trusted with real patient data.

As the integration lead, you will also coordinate multiple integrations running in parallel. As demand grows, integration work is delivered by parallel, ad-hoc teams that spin up around specific customers, EHRs, or go-lives — and you are the technical owner who keeps them aligned, sets the standards they follow, and ensures every concurrent integration lands consistently and on time.

• Design and build resilient, bidirectional integrations with major EHRs (Epic, Oracle Health/Cerner, athenahealth, MEDITECH, TruBridge/CPSI, Veradigm/Allscripts, eClinicalWorks, NextGen).

• Implement and maintain HL7v2 interfaces (ADT, ORU, ORM, SIU, MDM, DFT) and FHIR R4 / US Core integrations, including SMART on FHIR and Bulk FHIR.

• Build and operate integration pipelines on InterSystems IRIS (our integration platform) — and, where needed, via aggregators like Redox, Health Gorilla, or 1upHealth.

• Handle C-CDA documents, X12 transactions (270/271 eligibility, 837/835 claims), and the connectivity layer (MLLP, SFTP, TLS, VPN, OAuth2 client credentials).

• Navigate EHR vendor programs end-to-end: Epic (Showroom/App Orchard, Bridges, Interconnect), Oracle Health CODE, athenahealth Marketplace — including registration, security review, and go-live.

• Own reliability of the integration estate: monitoring, message reconciliation, replay/backfill, dead-letter handling, and clear fallback behavior when an interface or downstream EHR is degraded.

• Guarantee accuracy, patient-matching integrity, and de-identification/PHI handling across every data flow; partner with Security and Compliance on audits.

• Support customer and partner due-diligence and security reviews (questionnaires, BAAs, technical assessments) to quickly unblock access to production data and keep integrations on schedule.

• Coordinate multiple parallel, demand-driven integration teams — assigning work, reviewing designs, unblocking engineers, and keeping standards and timelines consistent across concurrent customer integrations.

• Plan capacity and sequence go-lives across the integration portfolio as ad-hoc teams spin up and down with demand.

• Set integration standards and mentor engineers; act as the organization's technical authority on interoperability.

• Collaborate closely with Backend, AI, Clinical, and Implementation teams to map clinical workflows into integration contracts.

• Write clean, test-driven, maintainable code; validate and own all AI-generated code contributions.

• 10+ years in software/integration engineering, with deep, demonstrated expertise building HL7v2 and FHIR integrations in production healthcare environments (including ancillary flows such as imaging/DICOM, scheduling, and ePrescribing/Surescripts).

• Experience coordinating multiple engineers or parallel workstreams across concurrent customers — comfortable keeping standards and delivery consistent in a fluid, demand-driven team structure.

• Must be based in the USA and authorized to work in the U.S. without sponsorship.

• Availability to travel within the USA as needed for customer onboarding, go-lives, and on-site integration work.

• Hands-on experience with at least one major EHR's interface/API surface (Epic, Oracle Health/Cerner, athenahealth, or MEDITECH) — ideally including a vendor certification or marketplace go-live.

• Production experience with InterSystems IRIS (our integration platform; Ensemble/HealthShare also relevant) — or a comparable engine (Mirth/NextGen Connect, Rhapsody, Cloverleaf) with the ability to ramp on IRIS quickly.

• Strong programming skills in Python (and comfort with JavaScript/TypeScript or Java/Groovy for engine scripting).

• Solid understanding of healthcare data: clinical terminologies (LOINC, SNOMED CT, ICD-10, CPT, RxNorm), patient matching, and EHR data models.

• Working knowledge of integration connectivity and security: MLLP, SFTP, REST, OAuth2/SMART, TLS/mTLS.

• Extensive experience working in a highly compliant environment under HIPAA/HITECH, SOC 2, and HITRUST controls.

• Reliability mindset: observability, idempotency, retries, reconciliation, and graceful degradation.

• Excellent communicator — clear, structured, concise (S.T.A.R / S.A.R or similar).

• Culture fit: kind, exceptionally smart, mission-driven, field expert.

• Experience with national interoperability networks: TEFCA/QHINs, Carequality, CommonWell, eHealth Exchange, or state/regional HIEs.

• Familiarity with Da Vinci, Argonaut, and US Core implementation guides, and CMS Interoperability & Prior Authorization rules.

• Cloud & DevOps literacy: GCP, Kubernetes, Docker, Terraform; event-driven architectures (queues/streams).

• Exposure to AI, RAG, or LLM workflows feeding/consuming EHR data.

• RHIA, CHPS, or equivalent health-informatics credential.

• New health systems are onboarded predictably and fast, with integration timelines measured in weeks, not quarters.

• Clinical data flows in and out of the platform with high integrity — accurate patient matching, correct mappings, and zero silent data loss.

• The integration estate runs with strong availability and full observability; failures are caught, contained, and replayed rather than discovered by customers.

• Every interface operates within our highly compliant, HIPAA-governed environment and passes customer security review without friction.

• AI-generated integration code is consistently elevated, corrected, and owned by you.

• Concurrent integrations stay coordinated and consistent in quality even as their number scales with demand.

Learn more about our mission: Why Quadrivia