Interview guides · HCA Healthcare

HCA Healthcare Software Engineer Interview Guide

HCA Healthcare Software Engineer interview guide: reported rounds, questions and how candidates describe the process.

The 60-second brief

As a Software Engineer at HCA Healthcare, you will play a vital role in developing and maintaining software solutions that enhance healthcare delivery and improve patient outcomes. This position is critical in ensuring that technology systems are efficient, reliable, and aligned with the organization’s mission to provide high-quality care. You will work on complex projects that impact various aspects of healthcare operations, from electronic health records to patient management systems. Your contributions as a Software Engineer will directly influence the effectiveness of healthcare services provided to millions of patients.

This guide is scoped to a Software Engineer candidate at HCA Healthcare.

Focus areas

C# (C Sharp)
SQL
Microservices

The HCA Healthcare interview process

HCA Healthcare candidates report 5 rounds over 4-6 weeks. The stages below are what candidates describe, not a published process.

Screening Call

Initial call to assess candidate's background and fit for the role.

What to demonstrate

Initial call to assess candidate's background and fit for the role
Depth in C# (C Sharp)

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.

Technical Interviews

Interviews that may include coding assessments or system design discussions.

What to demonstrate

Interviews that may include coding assessments or system design discussions
Depth in C# (C Sharp)

How to prepare

Answer aloud and timed: Can you explain the differences between RESTful and SOAP web services?
Answer aloud and timed: Discuss a recent project where you implemented a new technology or framework.

Interviews with HR

Meet with HR representatives to discuss company culture and values.

What to demonstrate

Meet with HR representatives to discuss company culture and values
Depth in C# (C Sharp)

How to prepare

Answer aloud and timed: How do you ensure code quality and maintainability in your work?
Answer aloud and timed: Tell me about a time you faced a significant challenge in a project. How did you overcome it?

Interviews with Hiring Managers

Engage with hiring managers to evaluate technical skills and team fit.

What to demonstrate

Engage with hiring managers to evaluate technical skills and team fit
Depth in C# (C Sharp)

How to prepare

Prepare two projects you led end to end, each with the decision you owned and what it cost.
Have three questions about the team's roadmap and how success is measured in the first six months.

Interviews with Team Members

Interact with potential team members to assess collaboration and communication.

What to demonstrate

Interact with potential team members to assess collaboration and communication
Depth in C# (C Sharp)

How to prepare

Answer aloud and timed: Share an example of how you handled conflict within a team.
Answer aloud and timed: What motivates you in your work, and how do you convey that to your team?

Where candidates lose points

Research the Company

Understand HCA Healthcare's mission and values. This will help you articulate your fit during interviews.

Practice Coding

Brush up on coding skills and algorithm questions, as technical assessments are a significant component of the interview process.

Prepare for Behavioral Questions

Reflect on your past experiences and prepare to discuss them in a structured manner, focusing on your role and impact.

Stay Up-to-Date

Familiarize yourself with industry trends and advancements in healthcare technology, as this knowledge can set you apart.

Questions & practice

Collapse a redelivered event batch into per-aggregate high-water marks

Easy · hashing · at-least-once · aggregation

You drain a batch of up to 5,000,000 events, each (aggregate_id BIGINT, aggregate_version INT, event_type, payload). The log guarantees order within one aggregate only; the batch merges 64 partitions, and a relay failover has redelivered a range, so an older version for an aggregate can appear after a newer one. Given a map of last_applied_version per aggregate, produce the events worth applying, at most one per (aggregate_id, version), plus the count discarded. Target O(n) time. State the memory for 2,000,000 distinct aggregates and what you do when it does not fit.

Approach

One pass, one hash map from aggregate_id to the highest version kept, and a discard counter. An event whose version is at or below last_applied_version for its aggregate is dropped without further work, which is the whole reason the event carries its version rather than a delta. O(n) expected time, O(d) space in distinct aggregates.
Keep the maximum, never the last occurrence. The redelivered range means the final appearance of an aggregate in the batch can be an older version than one seen earlier in the same batch, so last-wins applies stale state over newer state and the projection regresses with no error anywhere.
Cost the memory instead of calling it large: an 8-byte key plus a 4-byte version is 12 bytes of payload, and an open-addressed table held at a 0.7 load factor costs roughly 17 bytes per entry before per-slot metadata, so 2,000,000 aggregates is tens of megabytes in a native layout and several times that in a runtime that boxes both key and value.
If the distinct set exceeds memory, partition on hash(aggregate_id) mod P and reduce each partition independently. Every event for one aggregate hashes to the same partition, so the per-partition result is exact and the merge is concatenation rather than a second reduction.

Follow-up

The payload is a patch rather than a snapshot, so applying only the highest version loses the intermediate changes. What changes in your reduction?
How do you detect that version 7 arrived while version 6 was never delivered, and what should the consumer do about the gap?

Archive a resource graph without breaking live references or recursing

Medium · graph traversal · topological order · tenant isolation

Resources reference other resources within a tenant; for the largest tenant the reference table holds up to 2,000,000 nodes and 8,000,000 edges. Archiving a resource must archive everything reachable from it that nothing outside the set still references, refuse when a live external referrer exists, and terminate when references form cycles, which they legitimately do. Produce the archive order and the refusal list, targeting O(V+E). Say what stops the traversal crossing a tenant boundary, and why recursion is the wrong control structure at this size.

Approach

Load the subgraph with the tenant predicate on both endpoints of the edge, not only on the side you started from. Scoping the left table alone is the classic cross-tenant leak: one mis-entered edge then pulls another tenant's resources into the traversal and, worse, into the archive.
Traverse iteratively with an explicit stack. A 2,000,000-node graph can hold a chain deep enough to exhaust a native stack in the low tens of thousands of frames, and that failure is a process crash rather than an error you can return.
Treat cycles as data rather than corruption: compute strongly connected components with Tarjan in O(V+E) using its own explicit stack, then condense. The condensation is a DAG, so a topological order over it gives the archive order, and every member of a component archives in one transaction because no order within a cycle is valid.
Decide refusals with reverse edges. A candidate is archivable only if every in-edge originates inside the candidate set, so build the transpose or count in-degrees restricted to the visited set, and emit each blocked resource with the id of the external referrer, which is the only part of the answer an operator can act on.

Follow-up

The graph is read in one query and the archive writes a minute later. What can change in between, and how do you make the write safe?
The candidate set is 400,000 resources. Is that one transaction, and if not, what does a half-finished archive look like to a reader?

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?

Denormalise tenant onto revisions and backfill it live

Hard · denormalisation · online migration · backfill

resource_revision (revision_id, resource_id, version, actor_user_id, change_kind, patch, request_id, created_at) has 400M rows and no tenant column; tenant_id lives only on resource. Two reads need it: a tenant-scoped audit feed ordered by created_at DESC, and an offboarding purge. Both join back to resource today. Justify adding tenant_id to resource_revision against those two reads, name the anomaly the copy introduces and the constraint that prevents it, then give the ordered migration for a live table taking 1.2k writes/second — the lock each step takes, how the backfill is batched, and where each step stops being reversible. PostgreSQL 16.

Approach

Justify from the access path rather than from taste. Without the column, the audit feed either scans resource_revision by created_at and discards other tenants' rows, or resolves the tenant's resource_ids first and probes with them — both proportional to the tenant's whole history rather than to one page. With (tenant_id, created_at DESC, revision_id DESC) it is a seek that stops at 50 rows, and the purge becomes a ranged delete instead of a join.
Name the cost exactly: a second copy of a fact can disagree with the first. Make the disagreement unwritable rather than documented — add UNIQUE (resource_id, tenant_id) on resource so it can serve as a foreign-key target, then FOREIGN KEY (resource_id, tenant_id) REFERENCES resource (resource_id, tenant_id) on the revision table. A revision can then only ever carry its parent's tenant.
Step one, expand: ALTER TABLE resource_revision ADD COLUMN tenant_id BIGINT NULL, with no default, so it is a catalogue change and no rewrite. It still needs ACCESS EXCLUSIVE for an instant, and that instant queues behind the longest open transaction on the table while every later query queues behind it — set lock_timeout to 2s and retry rather than wait.
Step two, dual-write: deploy the writer that populates tenant_id on every new revision while reads still use the join. Reversible by redeploying the previous build, because nothing reads the column yet.

Follow-up

The backfill is half finished and a rollback is required. What state is the table in, and what does the previous build do with a half-populated column?
How do you verify the backfill actually finished, given rows are still being inserted while it runs?

Hold a per-tenant active cap against concurrent creates

Hard · write skew · isolation levels · constraints

A tenant on the standard plan may hold at most 50 resources with status='active'. The create handler runs SELECT count(*) FROM resource WHERE tenant_id = $1 AND status = 'active', compares to 50, then inserts. Two creates arrive 3 ms apart on different instances and the tenant lands at 51. Name the anomaly, say whether PostgreSQL 16 READ COMMITTED or REPEATABLE READ prevents it and why, then give an implementation that holds the cap at READ COMMITTED with the exact statements. Finally, say what changes when the cap is 'at most one running export per tenant' on job_run.

Approach

Name it: write skew. The two transactions read an overlapping set and write disjoint rows, so there is no row-level conflict for the engine to detect and each commit is individually legal.
Rule out the levels precisely. READ COMMITTED takes a fresh snapshot per statement and takes no lock on the counted rows, so both see 49. PostgreSQL's REPEATABLE READ is snapshot isolation: it removes non-repeatable reads and phantoms within the snapshot but still admits write skew, because the anomaly is not a re-read of a changed row, it is a read of a set that a concurrent transaction invalidates. Only SERIALIZABLE closes it, by tracking the read dependency and aborting one transaction with SQLSTATE 40001 — a guarantee that exists only if the application re-runs the whole transaction from the read.
Convert the set predicate into a single-row conflict: keep tenant.active_resource_count and run UPDATE tenant SET active_resource_count = active_resource_count + 1 WHERE tenant_id = $1 AND active_resource_count < 50 in the same transaction as the INSERT. Zero affected rows is the cap, returned as 409. The row lock serialises the decision at any isolation level, and contention is bounded to one tenant's row — which is also the fair-scheduling unit, unlike a global counter that would convoy every tenant behind one row.
State the cost you just took on: a counter is a second source of truth that can drift, so every path that changes status must adjust it inside the same transaction, and a periodic reconciliation has to exist, with resource_revision as the authority for what the count should have been.

Follow-up

A resource moves from archived back to active. Which statements change, and what breaks if the counter update and the status change land in different transactions?
The cap becomes plan-dependent and a plan can change mid-month. Where does the number 50 live, and who reads it?

What programming languages are you proficient in, and how have you applied them in your projects?

Medium · Technical / Domain Questions

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?

Can you explain the differences between RESTful and SOAP web services?

Medium · Technical / Domain Questions

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?

Discuss a recent project where you implemented a new technology or framework.

Medium · Technical / Domain Questions

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 ensure code quality and maintainability in your work?

Medium · Technical / Domain Questions

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?

You are given a set of requirements for a new application. What steps would you take to develop a project plan

Medium · Problem-Solving / Case Studies

You are given a set of requirements for a new application. What steps would you take to develop a project plan?

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?

If you had to improve an existing system, what factors would you consider first?

Medium · Problem-Solving / Case Studies

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?

Describe your approach to gathering requirements from non-technical stakeholders.

Medium · Problem-Solving / Case Studies

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 would you approach debugging a production issue?

Medium · Problem-Solving / Case Studies

Approach

Establish what changed and when, before forming any theory.
Pick a bisection that eliminates candidates whichever way it turns out.
Check the instrumentation before believing the symptom.
Separate the trigger from the cause; the deploy is rarely the bug.

Follow-up

What would you look at first, and what would it rule out?
How would you tell a cause from a coincidence here?

Suggested practice checklist

Built from the rounds and topics HCA Healthcare candidates report.

Day 1 — Map the HCA Healthcare loop

Write out the reported sequence: Screening Call, Technical Interviews, Interviews with HR, Interviews with Hiring Managers, Interviews with Team Members.
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 5 reported rounds, with the weakest marked.

Day 2 — Work C# (C Sharp)

Spend the session on C# (C Sharp), which HCA Healthcare candidates report being tested on.
Write one worked example in C# (C Sharp) and time yourself on it.

Deliverable: One timed worked example in C# (C Sharp).

Day 3 — Work SQL

Spend the session on SQL, which HCA Healthcare candidates report being tested on.
Write one worked example in SQL and time yourself on it.

Deliverable: One timed worked example in SQL.

Day 4 — Work Microservices

Spend the session on Microservices, which HCA Healthcare candidates report being tested on.
Write one worked example in Microservices and time yourself on it.

Deliverable: One timed worked example in Microservices.

Day 5 — Answer out loud: Technical / Domain Questions

Answer aloud, timed: What programming languages are you proficient in, and how have you applied them in your projects?
Answer aloud, timed: Describe your experience with software development methodologies (e.g., Agile, Scrum).

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

Day 6 — Answer out loud: Behavioral / Leadership

Answer aloud, timed: Tell me about a time you faced a significant challenge in a project. How did you overcome it?
Answer aloud, timed: Describe a situation where you had to work closely with a team. What role did you play?

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

Day 7 — Answer out loud: Problem-Solving / Case Studies

Answer aloud, timed: How would you approach debugging a production issue?
Answer aloud, timed: Imagine a client wants to add a feature that conflicts with existing architecture. How would you handle it?

Deliverable: Spoken answers to 2 reported Problem-Solving / Case Studies question(s), under time.

Behavioural preparation

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

Describe your experience with software development methodologies (e.g., Agile, Scrum).

Medium · Technical / Domain Questions

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?

Tell me about a time you faced a significant challenge in a project. How did you overcome it?

Medium · Behavioral / Leadership

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?

Describe a situation where you had to work closely with a team. What role did you play?

Medium · Behavioral / Leadership

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?

How do you prioritize tasks when working on multiple projects simultaneously?

Medium · Behavioral / Leadership

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?

Share an example of how you handled conflict within a team.

Medium · Behavioral / Leadership

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?

What motivates you in your work, and how do you convey that to your team?

Medium · Behavioral / Leadership

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?

Imagine a client wants to add a feature that conflicts with existing architecture. How would you handle it?

Medium · Problem-Solving / Case Studies

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?