Backend Lead

Key Responsibilities

• Own the backend of the platform end to end — the clinical record, orders, laboratory and radiology, billing and insurance, pharmacy and stock, and the services that hold them together
• Set the service and data design for these modules, and review every change that touches a clinical record, a price, a ledger or a claim
• Lead the backend engineers: set the standard, review their work in progress rather than only at the end, and keep the codebase something a new engineer can be productive in within a fortnight
• Turn what a hospital actually does into a model the software can hold, working from real documents — a tariff sheet, a rate contract, a scheme circular — which will be inconsistent, hand-maintained and full of exceptions
• Own the Application Programming Interface (API) contracts the web and mobile applications consume, and keep them stable enough to be relied on

Correctness You Can Prove

• Make every write auditable and attributable: who did it, when, and what it replaced — corrections by reversal, never by silent overwrite
• Hold the line on money and stock, where a rounding error is a real rupee in a real hospital's accounts and a stock count that drifts is medicine that cannot be found — Decimal for every amount, never a float
• Make clinical safety checks real: allergy and interaction checks, dose limits by age and weight, critical values that must reach a human, and alerts a doctor cannot silently lose
• Build multi-tenancy in from the first table — one platform serving many hospitals, with no path by which one can see another's data
• Own the reconciliation story: what the cashier counted, what the system says and what the day-end report shows must agree, and any difference must be explainable

Interoperability and Standards

• Own the interoperability strategy: Fast Healthcare Interoperability Resources (FHIR) R4 as the façade the outside world reads and writes, over an internal model designed for how hospitals actually run
• Deliver Ayushman Bharat Digital Mission (ABDM) compliance — Ayushman Bharat Health Account (ABHA) creation and linking, consent, and health information exchange
• Make sure the platform speaks to the equipment that already exists in the hospital: Health Level Seven (HL7) version 2 messages from laboratory analysers, and Digital Imaging and Communications in Medicine (DICOM) worklists for imaging
• Use standard terminologies where they earn their place — Logical Observation Identifiers Names and Codes (LOINC), Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT), International Classification of Diseases (ICD-10) — and map to them rather than making clinicians work in them
• Treat integration failure as normal: retries, dead letters, replay, and a system that keeps working when the hospital's internet does not

Delivery Oversight

• Keep the backlog for the backend sequenced and estimated honestly, and flag slippage the week it becomes likely
• Review pull requests with an eye on the data as much as the code — a migration that silently rounds is worse than a bug that crashes
• Own the automated tests around money, stock and clinical safety; these are the paths where tests are mandatory rather than encouraged
• Own the operational side too: what happens at three in the morning when something fails, and how anyone finds out

• Six or more years building backend services in production, with at least two setting direction for other engineers
• Strong Python, used with type hints and tested — or another typed backend language with the willingness to work in Python from day one
• Deep relational database skill: schema design, transactions and isolation levels, indexes, and the ability to read a query plan and act on it
• Have owned a system where correctness is auditable after the fact — healthcare, billing, payments, accounting, insurance, lending or similar
• Have modelled a domain that resisted simple modelling, and can explain the trade-offs you took and the ones you regret
• Comfortable with event-driven work: queues, at-least-once delivery, idempotency, ordering and replay
• Able to design an API another team consumes, and hold its contract stable
• Able to explain a technical constraint to a hospital accountant, and a hospital's billing rule to an engineer who has never seen a hospital bill
• Willing to sit at a billing counter or beside a doctor for a day and come back with the questions the specification missed
• Preferred experience with healthcare interoperability — FHIR, HL7 version 2, LOINC, SNOMED CT, ABDM or another national health data exchange
• Preferred experience with Indian Goods and Services Tax (GST), insurance and Third Party Administrator (TPA) claims, pharmacy or retail inventory with batch and expiry, or a system migrated off a legacy database