Interview guides · Irhythm Technologies

Irhythm Technologies Software Engineer Interview Guide

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

The 60-second brief

As a Software Engineer at Irhythm Technologies, you are at the intersection of digital healthcare, medical device manufacturing, and life-changing patient care. This role drives the design, development, and maintenance of secure, high-quality software systems, tools, and platforms that support the production and operation of advanced cardiac monitoring devices. You will build and optimize software solutions that process millions of heartbeats into clinically actionable information, helping shape a future where everyone has access to the best possible cardiac health solutions. The scope of this role ranges from crafting robust manufacturing software in C# to integrating low-level embedded serial communication protocols and establishing stringent cybersecurity controls.

This guide is scoped to a Software Engineer candidate at Irhythm Technologies.

Focus areas

C#
Secure software development lifecycle (SDLC)
Cybersecurity best practices

The Irhythm Technologies interview process

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

Phone Screen

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#

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

One or more interviews that may include coding challenges and system design questions.

What to demonstrate

One or more interviews that may include coding challenges and system design questions
Depth in C#

How to prepare

Answer aloud and timed: What is your experience with low-level embedded serial communication protocols such as UART and USB?
Answer aloud and timed: How would you implement identity management, Multi-Factor Authentication, and cryptographic best practices in a production software environment?

Behavioral Interviews

Interviews designed to gauge both hard and soft skills in a collaborative atmosphere.

What to demonstrate

Interviews designed to gauge both hard and soft skills in a collaborative atmosphere
Depth in C#

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 interviews above and write down what you would ask to confirm before it.

Where candidates lose points

Emphasize patient impact

Always ground your technical answers in the broader mission of improving cardiac health and patient care, as this mission drives decision-making across all teams.

Structure your architectural walkthroughs

When asked about past projects, use a clear narrative structure that covers scale, design trade-offs, security considerations, and regulatory compliance.

Highlight security-first thinking

Actively discuss how you incorporate threat modeling, vulnerability management, and secure coding practices into your everyday development workflow.

Show cross-functional fluency

Prepare anecdotes that demonstrate how you successfully partner with QA, manufacturing engineering, and regulatory teams to unblock projects.

Ask insightful questions

Use the collaborative portions of your interviews to ask about how the team balances product delivery speed with stringent medical device quality standards.

Questions & practice

How would you implement identity management, Multi-Factor Authentication, and cryptographic best practices in

Medium · Technical and Architecture Deep Dive

How would you implement identity management, Multi-Factor Authentication, and cryptographic best practices in a production software environment?

Approach

Restate the input: its shape, its size, and what is guaranteed about it.
Name the brute-force solution and its complexity before improving on it.
Choose the data structure from the access pattern, not from familiarity.
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?

Canonicalise a request body into a stable idempotency fingerprint

Medium · parsing · canonicalisation · hashing

idempotency_key.request_fingerprint is a SHA-256 over the method, path and canonicalised body, and a retry whose fingerprint differs must be rejected with 422 rather than served the stored response. Write the canonicaliser. Bodies are JSON up to 256 KB nested at most 32 levels; clients vary key order, whitespace and unicode escaping, and some send 64-bit ids as JSON numbers. Produce a deterministic byte string such that semantically identical bodies match and any semantic difference does not. State your complexity and name two normalisations you refuse to perform.

Approach

Parse once into a tree, then re-serialise under fixed rules: object keys sorted, array order preserved, one escaping convention, no insignificant whitespace. Parsing is O(n) and sorting keys is O(k log k) per object, so O(n log n) overall with O(depth) stack, and the 32-level cap is enforced during parsing because hostile nesting is how a canonicaliser becomes a stack overflow.
Sort keys by their UTF-8 bytes and say why the obvious implementation is wrong in some runtimes: a default string comparison that orders by UTF-16 code units places surrogate pairs, meaning code points from U+10000 up, below U+E000 to U+FFFF, which is not UTF-8 byte order, so two services written in different languages disagree on the same document.
Do not re-encode numbers through a double. IEEE-754 binary64 represents integers exactly only up to 2^53, so normalising a 19-digit id through a float changes it, and 1 against 1.0 cannot be reconciled without deciding whether they are the same value. Preserve the literal token, and require ids as strings at the API boundary if you want them comparable.
Reject duplicate keys rather than picking one. JSON permits them and parsers disagree, most keeping the last, so any choice you make ties the fingerprint to a parser detail that the code handling the request does not necessarily share.

Follow-up

A client sends the same logical request with an extra field your API ignores. Same key, different fingerprint, so you return 422. Is that the right answer?
Where does the fingerprint get computed relative to request decompression and the body-size limit?

Merge partitioned event streams into one ordered feed with bounded lateness

Hard · k-way merge · watermarks · out-of-order streams

The read-model service consumes 64 log partitions carrying about 4,000 events per second in total. Each partition is ordered within itself, but partitions drift by up to 30 seconds, and the activity feed must present a tenant's events in occurred_at order. Produce the merge. State its complexity, the buffer it requires in events and in bytes, what happens when one partition is idle, and what you do with an event that arrives after you have already emitted its position. Payloads average 1 KB.

Approach

Merge with a min-heap over the 64 partition heads keyed on (occurred_at, event_id): O(log P) per event and O(n log P) overall. The tie-break on event_id is what makes the output deterministic when two partitions carry the same millisecond, which matters because the feed is paginated and a non-deterministic order reorders pages under the reader.
Emitting the heap head is only correct once every partition has produced everything up to that timestamp, so the emit condition is a watermark: the minimum across partitions of the highest occurred_at seen, less the allowed lateness. Events are held until the watermark passes them, which is what turns individually ordered streams into a jointly ordered one.
Size the buffer from the lateness rather than guessing: 4,000 events per second times 30 seconds is 120,000 buffered events, and at 1 KB each about 120 MB of heap. That number is the real price of the ordering guarantee and belongs in front of whoever asked for it.
Handle the idle partition explicitly, because it fails the feed rather than corrupting it: a partition with no traffic never advances its own maximum, so the watermark freezes and output stops entirely. Either every partition emits a periodic idle marker carrying the broker's current time, or the watermark falls back to wall clock for a partition silent beyond a threshold.

Follow-up

The lateness budget is raised to five minutes. What is the new buffer, and what besides memory changes?
The consumer restarts. Where does it resume from, and what does the feed look like for the first 30 seconds?

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?

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?

Walk me through the architecture details of a complex software product you recently designed or worked on.

Medium · Technical and Architecture Deep Dive

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 designing secure C# software for manufacturing tools, fixtures, or backend systems?

Medium · Technical and Architecture Deep Dive

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?

Can you explain how you handle vulnerability management and threat modeling frameworks like STRIDE or OWASP?

Medium · Technical and Architecture Deep Dive

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 is your familiarity with software QA processes in regulated environments such as medical devices, aviatio

Medium · Regulatory Compliance and Quality Assura

What is your familiarity with software QA processes in regulated environments such as medical devices, aviation, or defense?

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 compliance with standards like IEC 62304, ISO 13485, and FDA cybersecurity guidance during d

Medium · Regulatory Compliance and Quality Assura

How do you ensure compliance with standards like IEC 62304, ISO 13485, and FDA cybersecurity guidance during daily development?

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?

Why is QA significant in software projects, and how do you support and collaborate with QA teams?

Medium · Regulatory Compliance and Quality Assura

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 verification and validation activities, including generating regulatory documentation?

Medium · Regulatory Compliance and Quality Assura

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 share an experience where you balanced delivery velocity with strict regulatory and security constrain

Medium · Regulatory Compliance and Quality Assura

Can you share an experience where you balanced delivery velocity with strict regulatory and security constraints?

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?

One customer endpoint stalls deliveries to every other destination

Medium · bulkhead · timeouts · saturation

The egress service delivers about 1.5k webhooks/second across 40,000 destinations, with a per-destination concurrency cap of 4 and a 10-second connect-plus-read timeout. Throughput falls to 300/second, queue depth climbs, and p99 delivery latency for unaffected destinations goes from 200 ms to minutes, while the error rate barely moves. One tenant holds 900 destination rows whose URLs share a hostname that now answers in 9.5 seconds. Explain the mechanism with the arithmetic, then give the containment in the order you would apply it.

Approach

Look at saturation before errors. A flat error rate with collapsing throughput says nothing is failing, things are waiting, so the first signal to pull is in-flight request count or pool wait time rather than the error counter. This is the distinction that decides the whole investigation.
Group in-flight work by resolved host, not by destination id. The cap is keyed per destination row, so 900 rows sharing one hostname buy 3,600 concurrent slots against a single host, each held for 9.5 seconds. The bulkhead was never a bulkhead for that host, and grouping by the wrong dimension is why the dashboard looked healthy.
Do the arithmetic in both directions. Required concurrency is arrival rate times latency, so 1.5k/second at 200 ms needs about 300 in flight, which is entirely consumed by 3,600 slow slots; conversely whatever concurrency is left sustains rate equals concurrency divided by 9.5 seconds, which is the 300/second you are seeing. Matching both numbers is what promotes this from a plausible story to the mechanism.
Explain why the circuit breaker never helped. It opens on consecutive failures, and a 9.5-second response inside a 10-second timeout is a success. Slow is not failing, so an error-rate breaker cannot see this; you need a slow-call ratio, a deadline propagated from the caller's remaining budget, or a concurrency limiter.

Follow-up

The host recovers to 80 ms. How long does the queue take to drain, and what does the drain do to the recovered host?
Where should the 10-second timeout number actually come from?

Suggested practice checklist

Built from the rounds and topics Irhythm Technologies candidates report.

Day 1 — Map the Irhythm Technologies loop

Write out the reported sequence: Phone Screen, Technical Interviews, Behavioral Interviews.
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 C#

Spend the session on C#, which Irhythm Technologies candidates report being tested on.
Write one worked example in C# and time yourself on it.

Deliverable: One timed worked example in C#.

Day 3 — Work Secure software development lifecycle (SDLC)

Spend the session on Secure software development lifecycle (SDLC), which Irhythm Technologies candidates report being tested on.
Write one worked example in Secure software development lifecycle (SDLC) and time yourself on it.

Deliverable: One timed worked example in Secure software development lifecycle (SDLC).

Day 4 — Work Cybersecurity best practices

Spend the session on Cybersecurity best practices, which Irhythm Technologies candidates report being tested on.
Write one worked example in Cybersecurity best practices and time yourself on it.

Deliverable: One timed worked example in Cybersecurity best practices.

Day 5 — Answer out loud: Technical and Architecture Deep Dive

Answer aloud, timed: Walk me through the architecture details of a complex software product you recently designed or worked on.
Answer aloud, timed: How do you approach designing secure C# software for manufacturing tools, fixtures, or backend systems?

Deliverable: Spoken answers to 2 reported Technical and Architecture Deep Dive question(s), under time.

Day 6 — Answer out loud: Regulatory Compliance and Quality Assurance

Answer aloud, timed: What is your familiarity with software QA processes in regulated environments such as medical devices, aviation, or defense?
Answer aloud, timed: How do you ensure compliance with standards like IEC 62304, ISO 13485, and FDA cybersecurity guidance during daily development?

Deliverable: Spoken answers to 2 reported Regulatory Compliance and Quality Assurance question(s), under time.

Day 7 — Answer out loud: Behavioral and Team Collaboration

Answer aloud, timed: Describe a time when you had to influence multidisciplinary teams or stakeholders who had conflicting priorities.
Answer aloud, timed: How do you mentor junior developers or guide teams on secure coding principles and risk mitigation?

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

Behavioural preparation

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

What is your experience with low-level embedded serial communication protocols such as UART and USB?

Medium · Technical and Architecture Deep Dive

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 time when you had to influence multidisciplinary teams or stakeholders who had conflicting prioriti

Medium · Behavioral and Team Collaboration

Describe a time when you had to influence multidisciplinary teams or stakeholders who had conflicting priorities.

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 developers or guide teams on secure coding principles and risk mitigation?

Medium · Behavioral and Team Collaboration

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 encountered a major performance or security issue across a software stack and how you

Medium · Behavioral and Team Collaboration

Tell me about a time you encountered a major performance or security issue across a software stack and how you resolved 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?

How do you handle ambiguity when project requirements or specifications change mid-development?

Medium · Behavioral and Team Collaboration

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 a time you advocated for doing things right the first time versus taking shortcuts under d

Medium · Behavioral and Team Collaboration

Share an example of a time you advocated for doing things right the first time versus taking shortcuts under deadline pressure.

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?