Interview guides · Highnote Health

Highnote Health Software Engineer Interview Guide

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

The 60-second brief

At Highnote Health, a Software Engineer—particularly in roles such as Principal Software Engineer or Principal Core Infrastructure Engineer—is a foundational architect of our mission to modernize healthcare infrastructure. You are not simply writing code; you are building the robust, scalable, and secure systems that power critical healthcare data exchanges. This role is pivotal in ensuring that our platforms remain performant and reliable under the complex demands of the health-tech ecosystem. You will be tasked with solving high-stakes challenges that sit at the intersection of distributed systems, data integrity, and high-availability architecture. Whether you are focusing on the Core Infrastructure that supports our entire product suite or driving the evolution of our application layer, your work has a direct, measurable impact on the speed and security of healthcare delivery.

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

Focus areas

Core Infrastructure Engineering
Software Engineering
Principal Engineer Scope

The Highnote Health interview process

Highnote Health candidates report 4 rounds over 3-5 weeks. The stages below are what candidates describe, not a published process.

Technical Screening

Initial assessment to evaluate foundational knowledge relevant to the role.

What to demonstrate

Initial assessment to evaluate foundational knowledge relevant to the role
Depth in Core Infrastructure Engineering

How to prepare

Answer aloud and timed: How would you design a scalable service to handle high-concurrency requests in a distributed environment?
Answer aloud and timed: What strategies do you employ to ensure high availability and disaster recovery for core infrastructure components?

System Design Session

In-depth discussion focused on system design concepts and architecture.

What to demonstrate

In-depth discussion focused on system design concepts and architecture
Depth in Core Infrastructure Engineering

How to prepare

Answer aloud and timed: How do you approach the trade-offs between consistency and availability in a distributed database system?
Answer aloud and timed: Describe a time you identified a bottleneck in a production system; what was your process for diagnosing and remediating it?

Deep-Dive Technical Discussion

Comprehensive technical interview covering specific technologies and problem-solving.

What to demonstrate

Comprehensive technical interview covering specific technologies and problem-solving
Depth in Core Infrastructure Engineering

How to prepare

Answer aloud and timed: Tell me about a time you had to influence a technical direction despite pushback from stakeholders.
Answer aloud and timed: How do you mentor junior engineers while balancing your own high-level individual contributor responsibilities?

Behavioral Assessment

Evaluation of past experiences and cultural fit through behavioral questions.

What to demonstrate

Evaluation of past experiences and cultural fit through behavioral questions
Depth in Core Infrastructure Engineering

How to prepare

Prepare three examples from your own work, each with a decision you made and an outcome you can quantify.
Re-read the description of the behavioral assessment above and write down what you would ask to confirm before it.

Where candidates lose points

Structure your answers

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

Be prepared to defend your choices

When discussing past projects, be ready to explain why you chose a specific technology or architecture over the alternatives.

Ask meaningful questions

Use the time at the end of interviews to ask about our engineering culture, our biggest technical challenges, and how we balance speed with stability.

Focus on the fundamentals

Even for senior roles, a lack of clarity on core computer science fundamentals can be a significant red flag.

Questions & practice

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?

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?

Find version gaps and relay lag with window functions

Medium · window functions · event tables · frame semantics

outbox_event holds event_id, aggregate_type, aggregate_id, aggregate_version, event_type, payload, status ('pending','published','dead'), attempts, created_at, published_at. A projection is missing rows and you must decide whether the relay skipped events or the consumer dropped them. Write three queries over the last seven days: one listing every aggregate_id whose published aggregate_version sequence has a hole, one giving per-day counts with a running total, and one returning the newest published event per aggregate. For each, say where the window function is evaluated relative to WHERE and LIMIT. PostgreSQL 16.

Approach

Gaps: compute lead(aggregate_version) OVER (PARTITION BY aggregate_id ORDER BY aggregate_version) in a subquery, then filter next_version <> aggregate_version + 1 in the outer query. Window functions are evaluated after WHERE, GROUP BY and HAVING and before the outer ORDER BY and LIMIT, so the predicate cannot sit in the same WHERE clause and PostgreSQL 16 has no QUALIFY.
Say what the seven-day filter does to the answer: it truncates every partition, so the first row per aggregate has no predecessor inside the window and a hole spanning the boundary is invisible. Widen the window, or join to resource.version as the authority for the true maximum.
Running total: SELECT date_trunc('day', created_at) AS d, count() AS n, sum(count()) OVER (ORDER BY date_trunc('day', created_at) ROWS UNBOUNDED PRECEDING). An aggregate inside a window call is legal because grouping runs before windowing. The grouping key is unique per row here so ROWS and RANGE agree, but write the frame anyway — over ungrouped rows with tied timestamps the default RANGE frame pulls in every peer row and the total jumps.
Newest per aggregate: DISTINCT ON (aggregate_id) ... ORDER BY aggregate_id, aggregate_version DESC is the cheap PostgreSQL-only form when an index matches that order; row_number() OVER (PARTITION BY aggregate_id ORDER BY aggregate_version DESC) = 1 is the portable form and needs a subquery for the same evaluation-order reason as the gap query.

Follow-up

Relay failover redelivers events. Does a duplicate break the gap query, and how would you detect one from this table alone?
Turn the gap check into a continuous monitor rather than a query someone runs after an incident. What does it watch?

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?

How would you design a scalable service to handle high-concurrency requests in a distributed environment?

Medium · System Design and Infrastructure

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 strategies do you employ to ensure high availability and disaster recovery for core infrastructure compon

Medium · System Design and Infrastructure

What strategies do you employ to ensure high availability and disaster recovery for core infrastructure components?

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?

How do you approach the trade-offs between consistency and availability in a distributed database system?

Medium · System Design and Infrastructure

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?

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 Highnote Health candidates report.

Day 1 — Map the Highnote Health loop

Write out the reported sequence: Technical Screening, System Design Session, Deep-Dive Technical Discussion, Behavioral Assessment.
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 4 reported rounds, with the weakest marked.

Day 2 — Work Core Infrastructure Engineering

Spend the session on Core Infrastructure Engineering, which Highnote Health candidates report being tested on.
Write one worked example in Core Infrastructure Engineering and time yourself on it.

Deliverable: One timed worked example in Core Infrastructure Engineering.

Day 3 — Work Software Engineering

Spend the session on Software Engineering, which Highnote Health candidates report being tested on.
Write one worked example in Software Engineering and time yourself on it.

Deliverable: One timed worked example in Software Engineering.

Day 4 — Work Principal Engineer Scope

Spend the session on Principal Engineer Scope, which Highnote Health candidates report being tested on.
Write one worked example in Principal Engineer Scope and time yourself on it.

Deliverable: One timed worked example in Principal Engineer Scope.

Day 5 — Answer out loud: System Design and Infrastructure

Answer aloud, timed: How would you design a scalable service to handle high-concurrency requests in a distributed environment?
Answer aloud, timed: What strategies do you employ to ensure high availability and disaster recovery for core infrastructure components?

Deliverable: Spoken answers to 2 reported System Design and Infrastructure question(s), under time.

Day 6 — Answer out loud: Leadership and Behavioral

Answer aloud, timed: Tell me about a time you had to influence a technical direction despite pushback from stakeholders.
Answer aloud, timed: How do you mentor junior engineers while balancing your own high-level individual contributor responsibilities?

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

Day 7 — Dry run for Highnote 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 a time you identified a bottleneck in a production system; what was your process for diagnosing and r

Medium · System Design and Infrastructure

Describe a time you identified a bottleneck in a production system; what was your process for diagnosing and remediating it?

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 had to influence a technical direction despite pushback from stakeholders.

Medium · Leadership and Behavioral

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 mentor junior engineers while balancing your own high-level individual contributor responsibilities

Medium · Leadership and Behavioral

How do you mentor junior engineers while balancing your own high-level individual contributor responsibilities?

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 navigate significant technical debt to deliver a new feature.

Medium · Leadership and Behavioral

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 your work when faced with competing high-impact projects?

Medium · Leadership and Behavioral

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?