Franciscan Health Software Engineer Interview Guide

The 60-second brief

At Franciscan Health, the Software Engineer role—often aligned with Coder Certified HCC Physician Practice or Hospital Inpatient Coder functions—sits at the critical intersection of clinical accuracy and data integrity. While titled as engineering, these roles are the backbone of our digital health infrastructure, ensuring that patient encounters are accurately translated into standardized codes that facilitate quality care, research, and financial sustainability. You will contribute to a high-impact environment where your precision directly influences the efficiency of our healthcare delivery systems. Whether you are navigating complex inpatient records or physician practice documentation, your work ensures that Franciscan Health maintains the highest standards of data compliance and operational excellence.

This guide is scoped to a Software Engineer candidate at Franciscan Health.

Focus areas

• HCC (Hierarchical Condition Categories)
• Inpatient Coding
• Physician Practice Coding

Where to focus your preparation

No round sequence has been reported for Franciscan Health. Confirm the format with your recruiter.

Preparation focus

No round sequence has been reported for this company, so confirm the format with your recruiter and work the reported questions below.

What to demonstrate

• Breadth across the topics this company reports testing
• Whether you confirm the format before preparing for it

How to prepare

• Ask the recruiter for the sequence, the duration of each stage and whether you will be writing code
• Work the reported questions below and time yourself

Where candidates lose points

Structure your answers

Use the STAR method (Situation, Task, Action, Result) to keep your behavioral responses focused and impactful.

Know the mission

Research Franciscan Health’s core values; we look for candidates who integrate those values into their professional conduct.

Ask thoughtful questions

Prepare 2–3 questions about the team’s current coding challenges or the department’s goals for the coming year.

Be ready for technical testing

Expect a short assessment or a case study review to verify your coding speed and accuracy.

Questions & practice

Which coding guidelines do you prioritize when you encounter ambiguous physician notes?

Medium · Technical and Clinical Proficiency

Approach

1. Restate the input: its shape, its size, and what is guaranteed about it.
2. Name the brute-force solution and its complexity before improving on it.
3. Choose the data structure from the access pattern, not from familiarity.
4. State the target complexity and say which constraint rules the naive version out.

Follow-up

• How does this change if the input no longer fits in memory?
• What is the worst case, and how likely is it on real data?

Find overlapping job attempts and peak concurrency from lease records

Medium · sweep line · intervals · leases

A day of job_run history yields about 50,000,000 attempt records: (job_run_id, job_type, attempt, started_at, finished_at which is NULL when the worker died, lease_expires_at). Leases expire on a clock, so a job that outran its lease ran twice. Produce (a) every job_run_id whose attempts overlapped in wall-clock time and (b) the peak number of simultaneously running attempts per job_type with the minute it occurred. Target O(n log n). State how you treat a NULL finished_at and what clock skew does to your answer.

Approach

1. Define the interval before sorting anything: an attempt occupies [started_at, COALESCE(finished_at, lease_expires_at)). finished_at is observed and lease_expires_at is only a promise, so every attempt without a finish contributes an estimate and the whole result is a lower bound on overlap rather than an exact count.
2. For peak concurrency, sweep: emit 2n endpoints, sort by (timestamp, kind) with ends ordered before starts at equal timestamps, then walk the sequence maintaining a counter per job_type and record each type's maximum with its timestamp. O(n log n) dominated by the sort, O(n) space, or O(1) extra if the sort is external and the walk streams.
3. For overlap detection, do not compare attempts pairwise. A single global sort by (job_run_id, started_at) gives both the grouping and the order; within a group, keep the maximum end seen so far and report an overlap exactly when the next start is less than that running maximum, which is one linear pass after the sort.
4. Half-open intervals matter and are easy to get wrong: with closed intervals an attempt ending at the same millisecond another begins reads as concurrency two, and across 50,000,000 records that artefact swamps the real signal.

Follow-up

• A handler is not idempotent and you have found 400 overlapping jobs. Which of them actually caused damage, and what would you query to find out?
• Peak concurrency for one job_type is 4 against a configured cap of 4. Is the cap working, or is the data hiding attempts that never started?

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

1. 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.
2. 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.
3. 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.
4. 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?

Replace offset paging on the resource feed with keyset

Easy · keyset pagination · composite index · sort order

resource holds resource_id, tenant_id, owner_user_id, title, body_ref, version, status ('draft','active','archived','deleted'), created_at, updated_at, deleted_at, with an index on (tenant_id, status, updated_at DESC, resource_id DESC). The listing endpoint returns active resources for one tenant, newest update first, 50 per page, today with LIMIT 50 OFFSET n. Tenants reach page 400 and rows are created while they read. Write the keyset query, define what the cursor carries and how it is encoded, and say which part of the index each predicate uses. Assume PostgreSQL 16.

Approach

1. Name the two failures separately. OFFSET 20000 makes the server produce and discard 20,000 rows, so page cost grows with depth rather than with page size. Independently, any write that changes how many rows sort above the offset moves the window between two fetches, and the direction decides which anomaly you get: an insert lands at the head of updated_at DESC and pushes already-returned rows down past the boundary, so they are returned a second time; a delete above the offset, or a row whose updated_at is bumped above the cursor, pulls rows up and one is never returned at all. Nothing in the response reveals either.
2. Write the seek: WHERE tenant_id = $1 AND status = 'active' AND (updated_at, resource_id) < ($2, $3) ORDER BY updated_at DESC, resource_id DESC LIMIT 50. The row-value comparison is one index range rather than a disjunction, and both columns are NOT NULL, which is what makes that comparison well defined.
3. Map each predicate onto the index: tenant_id and status are equality on the leading columns, (updated_at, resource_id) is the range, and the ORDER BY matches the index order so no Sort node appears and the scan stops after 50 rows. The DESC in the definition only matters for mixed directions — a plain ascending btree on the same columns is read backwards for this query.
4. Put both sort columns in the cursor and nothing the client can tamper with into another tenant: base64 of (updated_at, resource_id), validated server-side, with tenant_id taken from the principal.

Follow-up

• The client asks for 'jump to page 400'. What do you offer instead, and what does the honest version cost?
• Sort order becomes user-selectable across four columns. How many indexes is that, and which would you refuse to add?

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

1. 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.
2. 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.
3. 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.
4. 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 do you ensure accuracy when coding complex inpatient encounters?

Medium · Technical and Clinical Proficiency

Approach

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

Follow-up

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

Can you describe your process for identifying and resolving documentation discrepancies?

Medium · Technical and Clinical Proficiency

Approach

1. Clarify what is being asked and what a complete answer contains.
2. State your assumptions explicitly before working the problem.
3. Say what you would check first and why it is the highest-information step.
4. 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 stay updated with changes in coding regulations or compliance standards?

Medium · Technical and Clinical Proficiency

Approach

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

Follow-up

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

Every query on one table stalls for forty seconds mid-deploy

Medium · lock contention · ddl · migrations

During a release on PostgreSQL, every query touching resource times out for about 40 seconds and then recovers with no intervention. The release ran one migration, ALTER TABLE resource ADD COLUMN archived_reason TEXT, and the migration log shows it completing in 6 ms. Unrelated tables showed no change in error rate. Explain how a 6 ms statement caused a 40-second stall, give the ordered checks you would run on a live system to confirm it, and give the migration procedure that prevents a repeat.

Approach

1. Separate the statement's duration from the lock's duration. ADD COLUMN with no default is a catalogue-only change and genuinely runs in milliseconds, but it requires ACCESS EXCLUSIVE, and it cannot acquire that until every transaction already touching the table has finished.
2. Account for the queueing, which is the part that surprises people. A lock request that is waiting blocks later requests for conflicting modes behind it rather than letting them overtake, so one long-open transaction holds the DDL and the DDL holds all the traffic. The stall length is set by the longest open transaction, not by the size of the change.
3. Confirm on a live system in this order: pg_stat_activity for that table ordered by xact_start, looking for the oldest transaction and specifically for state = idle in transaction; then pg_locks where granted = false to find the waiter; then join them on pid to name blocker and blocked. pg_blocking_pids() does that join for you and is the fastest single call.
4. Prevent rather than merely time it better. Set lock_timeout to a second or two on the migration session so the DDL abandons the queue after a bounded wait and is retried, instead of holding it for as long as the oldest transaction lives. Be exact about what that buys: queries arriving during the wait still queue behind the pending ACCESS EXCLUSIVE request, so each attempt costs them up to one lock_timeout of added latency. The outage goes from 40 seconds to about one second per attempt, not to zero. Also run migrations away from deploy-time peaks, and put a statement timeout and an idle-in-transaction timeout on the analytics role that opens the long transactions.

Follow-up

• The same release also wants NOT NULL on that column. What is the sequence that gets there without a long lock?
• Your lock_timeout retry fails ten times in a row because the analytics transaction is always open. What do you change?

Suggested practice checklist

Built from the topics and questions Franciscan Health candidates report; no round sequence has been reported.

Day 1 — Establish the Franciscan Health format

• No round sequence has been reported, so ask your recruiter for the sequence, the duration of each stage and whether you will write code.

Deliverable: A written reply from your recruiter confirming the format.

Day 2 — Work HCC (Hierarchical Condition Categories)

• Spend the session on HCC (Hierarchical Condition Categories), which Franciscan Health candidates report being tested on.
• Write one worked example in HCC (Hierarchical Condition Categories) and time yourself on it.

Deliverable: One timed worked example in HCC (Hierarchical Condition Categories).

Day 3 — Work Inpatient Coding

• Spend the session on Inpatient Coding, which Franciscan Health candidates report being tested on.
• Write one worked example in Inpatient Coding and time yourself on it.

Deliverable: One timed worked example in Inpatient Coding.

Day 4 — Work Physician Practice Coding

• Spend the session on Physician Practice Coding, which Franciscan Health candidates report being tested on.
• Write one worked example in Physician Practice Coding and time yourself on it.

Deliverable: One timed worked example in Physician Practice Coding.

Day 5 — Answer out loud: Technical and Clinical Proficiency

• Answer aloud, timed: How do you ensure accuracy when coding complex inpatient encounters?
• Answer aloud, timed: Can you describe your process for identifying and resolving documentation discrepancies?

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

Day 6 — Rehearse your own examples

• Prepare three examples from your own work where you made the decision, each with the outcome you can quantify.

Deliverable: Three examples written out, each with a number attached.

Day 7 — Dry run for Franciscan Health

• 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 electronic health record systems and their impact on your workflow.

Medium · Technical and Clinical Proficiency

Approach

1. Pick a story where you made the decision, not one where you watched it.
2. State the situation in two sentences and spend the rest on the reasoning.
3. Give the blast radius: what could have broken, and what you measured.
4. 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?

Narrate an outage you owned from page to postmortem

Hard · incident response · blast radius · postmortems

Pick an incident you personally drove, ideally one where writes were affected rather than reads. In six to eight minutes: state the symptom as it first appeared on a dashboard, the blast radius you established before you knew the cause, the mitigation you applied and when, the mechanism you eventually proved, and the follow-up that would prevent a repeat. Bring numbers: error rate, tenants affected, minutes to mitigate, minutes to resolve. If you cannot name what you measured, choose a different incident.

Approach

1. Open on the signal rather than the cause: which metric at which percentile moved, on which service, at what time, so the listener follows the same evidence you had rather than a conclusion you already reached.
2. Separate mitigation from diagnosis out loud. State what you did to stop the bleeding (flag off, shed traffic, drain a lease, roll back a deploy) and say plainly that you did it before the mechanism was known, because those are two jobs with different deadlines.
3. Establish blast radius in countable terms: how many tenants, how many writes, and crucially whether the effect was loss or only delay. An append-only revision table or a pending outbox row means the change survived and the projection was merely behind, which is a repair rather than a data-loss incident.
4. Prove the mechanism instead of asserting it. Name the trace span that grew, the plan that flipped to a sequential scan, the lease that expired, plus one alternative you ruled out and the signal that stayed flat while you ruled it out.

Follow-up

• What would you do differently in the first five minutes, given the same dashboard and no more information?
• Which follow-up action did you deliberately not take, and why was dropping it the right call?

Tell callers you do not own that their integration breaks

Medium · deprecation · compatibility · stakeholders

A field in a write endpoint's response must change shape. You own the endpoint; you do not own the four internal callers or the outbound webhook consumers who read it. Describe a deprecation you were responsible for: what you shipped first, how you established who was actually reading the field, the window you gave and what set its length, what you did about the consumer who never moved, and how you decided removal was safe. Name the signal you used, not the announcement you sent.

Approach

1. Establish the reader set empirically rather than from a wiki of owners: per-field usage counters keyed by principal, or access logs attributed to a consumer. State the blind spot of whichever you pick, since a consumer that reads the field only on a monthly job will not appear in a week of logs.
2. Ship additive first. Populate the new field alongside the old one so no reader is forced to move, which is also what keeps a rolling deploy safe, because old and new instances answer the same requests at the same time and a rollback must still find the old shape present.
3. Set the window from the slowest legitimate consumer's release cadence, not from your calendar, and decide separately what to do for a consumer with no release process at all, such as an external webhook endpoint you can only email.
4. Convert silence into evidence before you rely on it: a short, low-traffic removal window that makes a still-dependent consumer fail visibly and loudly while you are watching, rather than at three in the morning after you have moved on.

Follow-up

• How would you detect a consumer that reads the field only during a monthly export?
• One caller refuses to move and has a commercial relationship behind it. What changes in your plan and what does not?