Senior Integration Engineer at Duet
About Duet
Duet is proving that nurse-practitioner-led care isn't just more accessible, it's better. We help NPs build and scale independent practices in communities too often overlooked by the health system: rural towns, immigrant populations, LGBTQ+ patients, and more. Backed by AI-driven tools that give independent NPs the backing of a much bigger system, our network of 100+ practices covering 400,000 annual visits has driven a 30% increase in preventative visits and a 35% drop in hospitalizations, the clearest sign yet that localized NP-led care means better outcomes.
We're a well-funded, early-stage company led by seasoned entrepreneurs and nurse practitioners, and backed by investors including Lerer Hippeau and Kairos.
Why Duet, Why Now
Independent primary care is disappearing, swallowed by hospital systems and private equity roll-ups, often pulling out of the communities that need it most. But 31 states now support autonomous NP practice, and the results back up what we've long believed. We built the first value-based care contracts for NPs with major payors, taking on real financial risk for outcomes. In our anchor market in New Hampshire, our network outperformed the state on total cost of care by 19%, proof that a solo NP in an underserved area can outperform a system ten times their size and get rewarded for it.
About the Role
As our Senior Integration Engineer, you'll own the pipelines that power Duet's platform. Our integrations touch EHRs across the ambulatory space—Athenahealth, eClinicalWorks, Elation—as well as clearinghouses and data warehouses, and they need to be reliable, observable, and extensible as we scale.
This is a highly technical IC role that sits at the intersection of integration engineering and product. You'll build new connections from scratch, harden the reliability of existing ones, and work closely with product and engineering to ensure the data flowing through our platform is timely, accurate, and usable. You'll share on-call responsibilities for integration reliability with the broader team.
You're not just a connector of systems—you're a builder who understands how data quality and pipeline reliability translate directly into practice outcomes and revenue.
What You'll Do
Build new EHR and clearinghouse integrations. Design and implement integrations with ambulatory EHRs (Athenahealth, eClinicalWorks, Elation) and clearinghouses, using FHIR, HL7v2, and EDI standards. Understand the quirks of each vendor and build integrations that handle real-world messiness gracefully.
Own integration reliability. Harden existing connections with observability, alerting, and automated failure recovery. Participate in shared on-call for integration incidents and build the tooling that makes incident response faster and root-cause analysis clearer.
Build the data pipelines that power our platform. Design and maintain the pipelines that ingest, transform, and deliver clinical, scheduling, billing, and claims data from source systems into our platform and data warehouse. Think carefully about latency, correctness, and schema evolution.
Partner with product on data-driven features. Work closely with the product and engineering team to understand what data is needed to power customer-facing features, and ensure the right data arrives in the right shape at the right time. Push back when upstream data quality makes a feature untrustworthy.
Set the standards for how we do integration. As our first dedicated integration engineer, you'll define how we approach connection design, error handling, retries, and monitoring. Document your decisions and build systems that future engineers can extend without fear.
What We're Looking For
5+ years of experience as an integration engineer, software engineer, or related discipline.
Strong Python programming skills; comfort reading and writing production-grade backend code.
Experience building and operating production data pipelines, including monitoring, alerting, and incident response.
A builder's orientation—you've worked in small teams where you had to figure things out from scratch, own decisions end-to-end, and move without a lot of process.
Strong communication skills; you can explain a complex integration failure to a non-technical operator as clearly as you can to an engineer.
Nice to Have
Strong command of healthcare interoperability standards: FHIR, HL7v2, and X12 EDI.
Clearinghouse or EDI experience (X12 835/837 claim submission and remittance workflows).
Experience with cloud data warehouses (BigQuery, Snowflake, or similar).
Cloud infrastructure experience (AWS or GCP).
Prior experience at a healthcare tech, RCM, or practice management company.
Familiarity with SMART on FHIR or OAuth-based EHR app frameworks.
Compensation
$160,000–$195,000 depending on experience. We also offer equity, competitive benefits, and a hybrid work environment in New York City.
If you're excited about this role, we encourage you to apply even if you don't meet every requirement listed. We care more about your ability to build and operate complex systems in ambiguous environments than any single line on your resume.