Founding Engineer / Tech Lead (Confidential)

Founding Engineer / Tech Lead — Ambra (CONFIDENTIAL search: do not reference Ambra's current team composition in outreach).

Ambra automates revenue cycle management (RCM) for ambulance billing. Hiring a founding engineer / tech lead to own technical architecture end to end: backend, frontend, infrastructure, DevOps, and security. This person will architect new systems (not just extend existing ones), make build-vs-buy calls, and eventually lead a small engineering team while staying hands-on.

Logistics: San Francisco, in-person/hybrid. Comp $170–220K base, 1.5–3.5% equity.

The persona: a systems-level thinker who has built zero-to-one products — someone who architected a system from scratch and lived with the consequences, not inherited someone else's architecture. Senior enough to have real depth (senior engineer at a strong tech company is the right level), scrappy enough to have done a bit of everything at an early-stage startup. People-oriented and willing to guide a small team, but still writing code and making technical decisions daily.

MUST-HAVES (all required):

1. Zero-to-one experience: has taken at least one product or system from nothing to production, ideally more than once. Startup experience (seed to Series B) strongly preferred.
2. Full-stack breadth: hands-on across backend, frontend, infrastructure/DevOps, and security — the profile of an engineer who had to do everything, not a specialist in one layer.
3. Architecture ownership: can point to a system they designed — API structure, data model, infra choices — and articulate trade-offs, failure modes, evolution.
4. Scaling instincts: can answer "if we 10x customers tomorrow, what breaks?" without hand-waving.
5. Team leadership without a big org: tech lead is the ideal current title — closer to the systems than an EM or VP, but has mentored/guided engineers and wants to.

STRONG PLUSES: healthcare experience (billing, claims, RCM, payers, clearinghouses) or demonstrated personal interest in fixing US healthcare; first or one of the first engineers at a company.

TARGET BACKGROUNDS: tech lead or staff/senior engineer who was employee #1–10 at a startup; senior engineer at a strong tech company with a startup/founding stint (either order); founding engineer at a startup that exited or wound down; healthtech engineers at companies touching claims, billing, or payer integrations.

ANTI-PATTERNS (auto-reject, do not send): big-company VPs/Directors of Engineering (too far from day-to-day development); long tenure at one large org with no zero-to-one work (e.g., 7 years maintaining one system) regardless of YOE; pure specialists (only frontend, only data, only infra) without breadth; managers who stopped coding more than ~2 years ago.

SCREENING PROXIES: "founding engineer," "first engineer," "employee #N," "built from scratch," "0→1" on profile; repos/side projects/launched products they personally architected; career arc showing both a rigorous environment (strong eng org) and a scrappy one (early startup); scope described as systems designed ("designed the billing pipeline," "built our API platform"), not features shipped on someone else's platform.

Interview process: systems design interview on an RCM-automation-style problem (API/system structure, assumptions, trade-offs, user-facing consequences, redesign under new requirements or 10x scale) plus a leadership/team conversation.