Principal Systems Engineer - Healthcare RCM Platform

Principal / Lead Azure Systems Engineer

Location: New York City (Remote to In-Person)

Full Time

Company: TissueConnect Systems

About Us

TissueConnect Systems is an emerging leader in AI-driven medical imaging solutions for orthopedic care. Founded by a team of orthopedic spine surgeons and medical students from the Hospital for Special Surgery, the world’s best orthopedic hospital, our mission is to transform patient care by developing quantitative imaging biomarkers to inform treatment approaches for a broad spectrum of musculoskeletal disease and predict associated outcomes. We combine cutting-edge computer vision, medical image analysis, and machine learning to unlock new insights from MRI imaging, one of the most widely obtained modalities of medical imaging, accelerating the translation of novel imaging biomarkers from research into clinical practice.

The Role

We are now expanding into a next-generation revenue cycle and EDI platform, MASIV, to connect our imaging technology natively into clinical and billing environments. MASIV enables seamless ingestion of patient demographics and imaging, insurance eligibility checks, claims routing, remittance automation, and enterprise data pipelines at scale. To build this, we are hiring a Systems Engineer / Azure Architect who will help build the cloud architecture of MASIV from the ground up.

You will build and scale MASIV — a HIPAA-compliant, Azure-native RCM system supporting X12 EDI flows, FHIR interoperability, clearinghouse integrations, claim adjudication, and provider billing.

You will collaborate with:

• Our ML / computer vision team
• Internal clinical product team
• Compliance, legal, RCM experts
• Provider partners and EHR vendors

This role is ideal for a builder who thrives in fast-paced environments and wants to make a tangible impact by bringing real-world AI applications to life.

Responsibilities

You will architect, build, and deploy critical MASIV subsystems, including:

1.       EDI & FHIR Interoperability

• Ingest X12 claim files (837P/837I, 835, 276/277)
• Support inbound provider uploads (SFTP, Azure Blob, Portal)
• Implement Logic Apps workflows with Integration Accounts & X12 schemas
• Convert between X12 and FHIR

2.       Clearinghouse & Provider Connectivity

• Build infrastructure to exchange claims, remittances, and claim status
• Integrate with technical clearinghouses (e.g. stedi.com or equivalent)

3.       Secure Multi-Tenant Architecture

• Implement a multi-tenant environment balancing isolation vs cost scalability
• Enforce HIPAA-grade boundary control

4.       Data Engineering for Billing Clinical

• Render EDI and clinical data into a medallion-style lakehouse
• Manage ingestion pipelines for real-time and batch
• Optimize for downstream ML workloads

5.       Payments

• Design and implement secure, scalable payment systems on Microsoft Azure leveraging payment card tokenization, ensuring full adherence to applicable PCI-DSS standards while managing compliance scope.
• Serve as the subject matter expert for operations at the nexus of PCI-DSS and HIPAA compliance within the Azure environment, developing and maintaining robust security protocols, including network segmentation, encryption, and secure access management for the Cardholder Data Environment (CDE).
• Collaborate with cross-functional development and operations teams, providing architectural guidance and creating comprehensive documentation to support all compliance efforts, security policies, and operational procedures for internal governance and external auditors. 

6.       Adjudication & Patient Responsibility

• Integrate real-time eligibility (270/271) to support accurate pre-service estimates and coverage validation.
• Implement patient responsibility and adjudication workflows aligned with payer rules, secondary billing, and remittance outcomes.
• Support claim attachment and supporting documentation flows, including payer-specific routing, barcoded cover sheets, and templated submission requirements.

Qualifications

• Bachelor’s, Master’s, or PhD in Computer Science, Biomedical Engineering, Electrical Engineering, or related field.
• Azure Solutions Architect Expert certification. Additional Azure certifications a plus.
• Healthcare IT Experience: Prior experience in healthcare IT, including familiarity with EMR/EHR systems integration. Experience with Epic integration is a plus.
• Deep Azure experience across:
• Azure SQL / PostgreSQL / CosmosDB
• Azure Data Factory
• Power BI
• Azure Storage SFTP endpoints
• Azure API Management
• Logic Apps Integration Accounts (X12, HL7v2)
• Power Platform
• Azure DevOps
• Azure App Service
• Azure Functions
• Azure Event Grid
• Health Data Services: Demonstrated experience with Azure Health Data Services, including designing, implementing, and optimizing solutions
• FHIR store
• AHDS security model
• Role and identity isolation
• Liquid templates & format conversion
• Data Architecture: Solid understanding of data architecture principles, including cloud computing and proficiency in Azure data services like Azure Data Lake Storage, Synapse Analytics or Databricks (Spark), and data modeling software
• Compliance & Security: Expertise in navigating HIPAA/HITECH and implementing secure data solutions. Experience with tools like Microsoft Purview and Microsoft Priva for compliance is a plus.
• Data Integration & ETL: Experience designing and implementing data pipelines, ETL processes, integrations with systems like EMRs (especially Epic) and HIEs, claim ingestion / clearinghouse APIs, and X12 message flows.
• API Development: Experience in designing and building secure APIs for data exchange and for line-of-business applications
• Cloud Security Frameworks: Familiarity with cloud security frameworks and tools like Azure Security Center and Azure Sentinel
• Infrastructure as Code (IaC): Experience with tools like Terraform, Bicep/ARM templates, and PowerShell for automating deployments
• Soft Skills: Strong communication and stakeholder management skills are crucial, particularly when collaborating with clinical, operational, and executive teams, as well as mentoring junior engineers

Why Join Us?

At TissueConnect Systems, you’ll be part of a mission-driven team working at the frontier of medical AI. You will have the opportunity to:

• Contribute to technology that could redefine clinical management of musculoskeletal health and diseases. 
• Work with a diverse and inclusive multidisciplinary team of engineers and clinicians.
• Grow your skills in a dynamic, fast-moving startup environment.

Location

Remote (U.S.) temporarily, but able to transition to in-person work in New York City in approximately 6 months.

Compensation

Highly competitive salary equity benefits, commensurate with experience. If you’re excited about our mission, we want to hear from you.

The base salary for this role is $200,000 -  260,000.

Where you land within the range will reflect your skills and experience, while keeping team parity in mind and leaving room for future growth.

How to Apply

If you’re excited to help shape the future of medical AI and revenue cycle management, send your resume and a brief introduction to nathooi@tissueconnect.ai (Isaac) and finosk@tissueconnect.ai (Kyle), two of our cofounders.