Interview guides · Denver Health and Hospital Authority

Denver Health and Hospital Authority Software Engineer Interview Guide

Denver Health and Hospital Authority Software Engineer interview guide: reported rounds, questions and how candidates describe the process.

The 60-second brief

A Software Engineer at Denver Health and Hospital Authority plays a pivotal role in a mission-driven environment that serves as Colorado's primary "safety-net" healthcare institution. Unlike traditional tech firms, engineering here is directly tied to patient outcomes and public health initiatives. You will be responsible for developing, maintaining, and optimizing the digital infrastructure that supports everything from Level I trauma care to specialized services like the Rocky Mountain Poison Control Center. The impact of this role is profound. Whether you are working as a Coder IV on legacy systems or an Epic Application Analyst integrating laboratory modules like Beaker, your work ensures that clinicians have the data they need to save lives.

This guide is scoped to a Software Engineer candidate at Denver Health and Hospital Authority.

Focus areas

Software Engineering (General)
Healthcare IT Systems
Beaker (Lab Software Component)

The Denver Health and Hospital Authority interview process

Denver Health and Hospital Authority candidates report 3 rounds over 3-5 weeks. The stages below are what candidates describe, not a published process.

Recruiter Screen

Initial contact to discuss your background and interest in the Software Engineer role.

What to demonstrate

Initial contact to discuss your background and interest in the Software Engineer role
Depth in Software Engineering (General)

How to prepare

Be able to walk your CV end to end in two minutes, and say why this company specifically.
Have your salary expectations, notice period and location constraints ready, and ask for the rest of the loop in writing.

Panel Interviews

Intensive rounds featuring panel interviews with managers and senior-level employees.

What to demonstrate

Intensive rounds featuring panel interviews with managers and senior-level employees
Depth in Software Engineering (General)

How to prepare

Answer aloud and timed: What are the primary security considerations when handling Protected Health Information (PHI)?
Answer aloud and timed: Describe your experience with SQL performance tuning for large datasets.

Final Decision

The final decision-making period, which may take several weeks as the team coordinates across departments.

What to demonstrate

The final decision-making period, which may take several weeks as the team coordinates across departments
Depth in Software Engineering (General)

How to prepare

Answer aloud and timed: How do you approach version control when working on a large, multi-contributor codebase?
Answer aloud and timed: Tell me about a time you went above and beyond to help a teammate.

Where candidates lose points

Research the Mission

Spend time understanding Denver Health and Hospital Authority's role as a safety-net hospital. Being able to articulate why this mission matters to you will set you apart from candidates who only focus on the tech.

Prepare for the Panel

You will likely meet several people at once. Practice maintaining engagement with multiple interviewers and tailoring your answers to their specific roles (e.g., more technical for engineers, more process-oriented for managers).

Ask Thoughtful Questions

Use the time at the end of the interview to ask about the team's current challenges, the tech stack’s evolution, or how the department supports professional growth.

Follow-up communication can sometimes be slow

If you haven't heard back within the timeframe they specified, a polite follow-up email after one week is appropriate, but be prepared for a longer administrative process.

Questions & practice

Explain the difference between synchronous and asynchronous processing in the context of a lab result notifica

Medium · Technical and Domain Knowledge

Explain the difference between synchronous and asynchronous processing in the context of a lab result notification system.

Approach

Say what the runtime actually does before reasoning about the code.
Name what is shared across threads and what owns each piece of state.
Identify the window where an invariant is briefly untrue.
Distinguish a value from a reference to it, and say which one you handed out.

Follow-up

What happens if two callers reach this at the same time?
Where could this allocate more than you expect?

Identify the heaviest tenants in a five-minute window under memory pressure

Medium · top-k · heavy hitters · streaming

The edge service handles about 3,000 requests per second across roughly 50,000 tenants, peaking near 9,000. Expose the 50 heaviest tenants by request count over the trailing five minutes so limits can be tightened before one tenant's backfill starves the fleet. You may not retain five minutes of raw records. Give the exact solution and its memory, then the bounded-memory approximation with its error stated as a formula, and say which you would ship and at what tenant cardinality that choice changes.

Approach

Do the exact version first, because it is affordable at this cardinality: a ring of 300 one-second counters per tenant, advanced lazily, is 1,200 bytes of counters per tenant and roughly 60 to 90 MB for 50,000 tenants with overhead. Carry a running total and subtract the bucket you overwrite so a window read is O(1) rather than 300 adds.
Extract the top 50 with a size-k min-heap over the tenant sums: O(d log k) for d tenants, against O(d log d) to sort them all. Maintaining the heap continuously instead of on query requires a tenant-to-heap-index map, because incrementing a count already inside the heap means sifting from a known position, and without that map you rebuild the heap on every request.
State the approximation precisely rather than gesturing at sketches. Misra-Gries with m counters retains every item whose true count exceeds N/(m+1), and each retained count underestimates the truth by at most N/(m+1). With m = 1,000 and N = 900,000 requests in the window the error is roughly 900 requests, which is fine for spotting a tenant sending 50,000 and useless for ranking two tenants 200 apart.
Say what breaks when the window slides: Misra-Gries and Space-Saving are insert-only and cannot be decremented as records age out. The workable construction is one summary per sub-window, say ten seconds, with 30 summaries merged at query time, and the merged error is the sum of the per-summary errors, so the bound degrades linearly in the number of sub-windows.

Follow-up

The heaviest tenant is heavy because of one export job rather than user traffic. Should the limiter treat those as the same tenant?
Two tenants sit tied at the boundary of the top 50. Does your answer flap, and does the flapping matter?

Track a rolling failure rate per destination for circuit decisions

Easy · sliding window · ring buffer · circuit breaker

The egress service delivers about 1,500 webhooks per second across roughly 40,000 destinations, each call bounded by a 10 second timeout. Maintain, per destination, the failure rate over the trailing 60 seconds so a caller can ask before dispatch whether the circuit should open. Attempts arrive as (destination_id, finished_at_ms, outcome). Requirement: amortised O(1) per attempt, with total memory bounded by the destination count rather than by traffic. Give the structure, its exact memory, and the rule that stops a destination with three attempts from opening a circuit.

Approach

Name the exact-deque version and then reject it as the default. Holding timestamps and advancing a tail pointer past anything older than now minus 60 seconds is a correct two-pointer window at amortised O(1) per attempt, but its memory tracks in-window traffic, so one destination in a retry storm holds hundreds of thousands of entries while thousands of quiet destinations hold none.
Use a ring of 60 one-second buckets per destination, each bucket a pair of counters for attempts and failures. On an attempt, advance the ring by the elapsed whole seconds, zeroing at most min(elapsed, 60) buckets, then increment the head. That is amortised O(1) with a fixed footprint per destination.
State the footprint: 60 buckets times two 4-byte counters is 480 bytes of payload per destination, so 40,000 destinations is roughly 20 to 25 MB with per-entry overhead, bounded by the catalogue rather than by the rate. The cost is granularity, since the oldest bucket ages out in whole seconds, which is far tighter than the decision needs.
Require a minimum sample before the circuit may open. A destination with three attempts and three failures reads as 100 percent and is not evidence; a floor of roughly 20 attempts in the window makes the ratio meaningful, and below that floor use a run of consecutive failures as the trigger instead.

Follow-up

The fleet is 30 instances and each sees roughly a thirtieth of a destination's traffic. Where does the rate actually live, and what does a per-instance answer get wrong?
A destination answers in 9.5 seconds and succeeds. It is not failing but it is consuming your per-destination concurrency. What signal should open the circuit here?

Stop tag and share joins from fanning out a page

Medium · join fan-out · semi-joins · many-to-many

resource_tag is (resource_id, tag_id) with PK (resource_id, tag_id); resource_share is (resource_id, shared_with_user_id, permission). The tagged-and-shared listing inner-joins resource to both, filters tenant_id, tag_id = ANY($2) and shared_with_user_id = $3, orders by updated_at DESC and takes 50. Pages come back with fewer than 50 distinct resources and the total in the header is far too high. Explain the row multiplication, rewrite both the page query and the count query so each is correct, and name the index each one needs. PostgreSQL 16.

Approach

Do the arithmetic against the predicates that are actually there. An inner join emits one row per matching child row, and both joins are filtered: tag_id = ANY($2) admits only the requested tags, shared_with_user_id = $3 admits one user's share rows. So a resource holding three of the requested tags and shared with $3 once yields three rows, not one — the multiplier is its count of matching tags times its share rows for that single user, and that second factor is 1 unless the table admits duplicate (resource_id, shared_with_user_id) pairs. LIMIT 50 then limits rows rather than resources, and COUNT(*) counts pairs — the header is the product, not the population.
Reject DISTINCT as the fix. It deduplicates after the product has been built, so the planner must materialise and sort the fanned-out set before the LIMIT can apply, and it leaves any SUM or AVG in the same select list wrong.
Rewrite both filters as semi-joins, keeping resource as the only row source: AND EXISTS (SELECT 1 FROM resource_tag rt WHERE rt.resource_id = r.resource_id AND rt.tag_id = ANY($2)) and the same shape against resource_share. A semi-join stops at the first match per resource and preserves the driving index order, so ORDER BY updated_at DESC, resource_id DESC LIMIT 50 still stops after 50 rows.
Count with the same predicates and no join at all: SELECT count(*) FROM resource r WHERE r.tenant_id = $1 AND r.status = 'active' AND EXISTS (...) AND EXISTS (...). Nothing multiplies a resource, so the number is the population.

Follow-up

The filter changes from 'any of these tags' to 'all of these tags'. Rewrite it and state what it costs relative to the ANY form.
A resource can be shared with the same user twice under different permissions. Does your count change, and should it?

Keep soft-deleted accounts from blocking re-registration

Easy · soft delete · unique constraints · engine differences

app_user holds user_id, tenant_id, email CITEXT, password_hash (NULL for SSO principals), email_verified_at, auth_version, status ('invited','active','suspended','deactivated'), created_at, updated_at, deleted_at. Two live accounts for one address inside a tenant must be impossible, but an address freed by a soft delete must be reusable, and the same tenant may delete and re-register it repeatedly. Write the uniqueness DDL for PostgreSQL 16, then the equivalent for MySQL 8 where partial indexes do not exist, and say what each permits once three deleted rows already hold that address.

Approach

Start from what is actually unique: not (tenant_id, email), but (tenant_id, email) among live rows. PostgreSQL says that directly — CREATE UNIQUE INDEX app_user_live_email ON app_user (tenant_id, email) WHERE deleted_at IS NULL. A full constraint over the same two columns burns the address permanently the first time someone deletes an account.
Keep case-insensitivity in the type or the index, never in the application: CITEXT as given, or UNIQUE (tenant_id, lower(email)) as an expression index where the extension is unavailable. A case-sensitive unique column is exactly how two accounts for one human appear.
For MySQL 8 the predicate has to move inside the key: add a discriminator column that is a constant 0 while the row is live and is set to user_id on delete, with UNIQUE (tenant_id, email, deleted_marker). Live rows share the constant and still collide; deleted rows differ from each other and stop colliding.
State the NULL variant and its dependency: leaving the marker NULL for deleted rows also works, because a unique index treats NULLs as distinct — true in MySQL, and true in PostgreSQL only under the default NULLS DISTINCT, which PostgreSQL 15 lets you reverse. Check the polarity against the three existing deleted rows: constant-on-live is what preserves the collision you want, and reversing it silently admits duplicate live accounts.

Follow-up

A deleted account re-registers with the same address the next day. Do the old resource rows follow the new user_id, and how does the API keep the two principals apart?
How do you honour an erasure request while resource_revision.actor_user_id still references this table?

How would you design a database schema to track patient vaccinations across multiple clinics?

Medium · Technical and Domain Knowledge

Approach

Fix the scope first: who calls this, how often, and what they do when it fails.
Name the read and write paths separately; they rarely have the same bottleneck.
Choose a partition key and say what query it makes expensive.
State the consistency you need, and where you are willing to be stale.

Follow-up

What breaks first when traffic grows ten times?
How does this behave when that dependency is down for an hour?

What are the primary security considerations when handling Protected Health Information (PHI)?

Medium · Technical and Domain Knowledge

Approach

Clarify what is being asked and what a complete answer contains.
State your assumptions explicitly before working the problem.
Say what you would check first and why it is the highest-information step.
Work from the requirement backwards to the design.

Follow-up

What assumption would you test first?
How would you know your answer was wrong?

How do you approach version control when working on a large, multi-contributor codebase?

Medium · Technical and Domain Knowledge

Approach

Clarify what is being asked and what a complete answer contains.
State your assumptions explicitly before working the problem.
Say what you would check first and why it is the highest-information step.
Work from the requirement backwards to the design.

Follow-up

What assumption would you test first?
How would you know your answer was wrong?

p99 jumped on one listing filter while p50 stayed flat

Medium · query planning · composite index · percentiles

After a release that added an owner_user_id filter to the resource listing, p99 rose from 90 ms to 1.9 s while p50 stayed at 40 ms. Traffic and row counts are unchanged. resource carries the index (tenant_id, status, updated_at DESC, resource_id DESC). The new query filters tenant_id and owner_user_id, orders by updated_at DESC, resource_id DESC, and takes 20 rows. On PostgreSQL, explain the shape of the regression, prove it from a query plan, and give the index you would add.

Approach

Start from the shape. A flat p50 with a moved p99 means a subset of requests changed cost, not all of them, so the first job is naming the subset. Bucket the endpoint's latency by the tenant's row count; the natural hypothesis is that large tenants are a small share of requests and all of the tail.
Get the plan for the new query on a large tenant with EXPLAIN (ANALYZE, BUFFERS). Expect an index scan over the tenant's range, a filter discarding most of it, then a Sort feeding the Limit, possibly reporting Sort Method: external merge Disk. Read actual rows on the scan node, not estimated.
Explain why the existing index cannot serve it. A composite B-tree is seekable only as a left prefix, and with no equality predicate on status the scan cannot treat updated_at as an ordering, because rows in the tenant's range are ordered by status first. Everything matching must be read and sorted before LIMIT 20 can apply, so a tenant with 400,000 rows pays 400,000 rows to return 20.
Add (tenant_id, owner_user_id, updated_at DESC, resource_id DESC). Equality on the first two columns leaves the index ordered by updated_at within that pair, so the plan becomes an index scan that stops after 20 rows with no Sort node. PostgreSQL can scan a B-tree backwards, so the DESC markers matter only if the two sort columns ever disagree in direction; keeping them explicit documents the order the keyset cursor depends on.

Follow-up

The endpoint paginates with OFFSET. What does page 500 cost with your index, and what does the keyset version cost?
How would you have caught this before release, given that a 10,000-row seed database produces the same plan shape at an unnoticeable cost?

Suggested practice checklist

Built from the rounds and topics Denver Health and Hospital Authority candidates report.

Day 1 — Map the Denver Health and Hospital Authority loop

Write out the reported sequence: Recruiter Screen, Panel Interviews, Final Decision.
For each round, write one sentence on what it is judging, from the description above, and mark the one you are least ready for.

Deliverable: A one-page map of the 3 reported rounds, with the weakest marked.

Day 2 — Work Software Engineering (General)

Spend the session on Software Engineering (General), which Denver Health and Hospital Authority candidates report being tested on.
Write one worked example in Software Engineering (General) and time yourself on it.

Deliverable: One timed worked example in Software Engineering (General).

Day 3 — Work Healthcare IT Systems

Spend the session on Healthcare IT Systems, which Denver Health and Hospital Authority candidates report being tested on.
Write one worked example in Healthcare IT Systems and time yourself on it.

Deliverable: One timed worked example in Healthcare IT Systems.

Day 4 — Work Beaker (Lab Software Component)

Spend the session on Beaker (Lab Software Component), which Denver Health and Hospital Authority candidates report being tested on.
Write one worked example in Beaker (Lab Software Component) and time yourself on it.

Deliverable: One timed worked example in Beaker (Lab Software Component).

Day 5 — Answer out loud: Technical and Domain Knowledge

Answer aloud, timed: How would you design a database schema to track patient vaccinations across multiple clinics?
Answer aloud, timed: Explain the difference between synchronous and asynchronous processing in the context of a lab result notification system.

Deliverable: Spoken answers to 2 reported Technical and Domain Knowledge question(s), under time.

Day 6 — Answer out loud: Behavioral and Leadership

Answer aloud, timed: Tell me about a time you went above and beyond to help a teammate.
Answer aloud, timed: Describe a situation where you had to meet a tight deadline with incomplete requirements.

Deliverable: Spoken answers to 2 reported Behavioral and Leadership question(s), under time.

Day 7 — Dry run for Denver Health and Hospital Authority

Run one full mock under time, then write down the two questions you most want to ask your interviewers.

Deliverable: A completed timed mock and two questions to ask.

Behavioural preparation

Behavioural rounds judge the decision you made and what it cost.

Describe your experience with SQL performance tuning for large datasets.

Medium · Technical and Domain Knowledge

Approach

Pick a story where you made the decision, not one where you watched it.
State the situation in two sentences and spend the rest on the reasoning.
Give the blast radius: what could have broken, and what you measured.
Name the disagreement and how you resolved it with evidence.

Follow-up

What would you do differently if you ran that again?
How did you know your change caused the improvement?