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North East Medical Services Software Engineer Interview Guide

North East Medical Services Software Engineer interview guide: reported rounds, questions and how candidates describe the process.

The 60-second brief

At North East Medical Services, the Software Engineer role is central to our mission of providing high-quality, comprehensive health care to our community. You will be tasked with building and maintaining the digital infrastructure that enables our clinical and administrative staff to deliver seamless patient experiences. Whether you are working on Epic application systems or developing internal tools for risk adjustment and health coding, your contributions directly impact the efficiency of our medical services and the accuracy of our patient data. This role requires a unique blend of technical precision and empathy for the clinical environment. You are not just writing code; you are solving problems that remove friction for healthcare providers, allowing them to focus on what matters most: the patients.

This guide is scoped to a Software Engineer candidate at North East Medical Services.

Focus areas

EPIC EHR Applications (Epic Application Analyst)
Risk Adjustment (HCC)
Health Coding / Medical Coding

The North East Medical Services interview process

North East Medical Services candidates report 3 rounds over 3-5 weeks. The stages below are what candidates describe, not a published process.

Experience Review

A high-level review of your experience and qualifications.

What to demonstrate

A high-level review of your experience and qualifications
Depth in EPIC EHR Applications (Epic Application Analyst)

How to prepare

Answer aloud and timed: How have you optimized a database or system for better performance in a high-volume environment?
Answer aloud and timed: Describe your experience integrating third-party software with existing clinical or administrative workflows.

Technical Deep Dives

In-depth technical discussions where you will be challenged on your technical choices.

What to demonstrate

In-depth technical discussions where you will be challenged on your technical choices
Depth in EPIC EHR Applications (Epic Application Analyst)

How to prepare

Answer aloud and timed: What is your process for troubleshooting a critical system failure in a production environment?
Answer aloud and timed: How do you ensure data integrity and security when handling sensitive patient information?

Behavioral Assessment

Evaluation of your behavioral fit and cultural addition to the team.

What to demonstrate

Evaluation of your behavioral fit and cultural addition to the team
Depth in EPIC EHR Applications (Epic Application Analyst)

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

Own your narrative

Be ready to talk about the most challenging project you've worked on and exactly what your contribution was.

Ask meaningful questions

Use the time at the end of the interview to ask about our team's biggest technical challenges or how we prioritize work.

Focus on the "Why

Don't just explain what you did; explain why you chose that approach over alternatives.

Be ready for ambiguity

In healthcare, requirements change. Show us how you adapt when the scope of a project shifts.

Questions & practice

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?

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

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.
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.
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.
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?

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?

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?

Keep soft-deleted accounts from blocking re-registration

Easy · soft delete · unique constraints · engine differences

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

Approach

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

Follow-up

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

How have you optimized a database or system for better performance in a high-volume environment?

Medium · Technical & Domain Expertise

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 data integrity and security when handling sensitive patient information?

Medium · Technical & Domain Expertise

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?

Explain your approach to maintaining legacy code while introducing modern features.

Medium · Technical & Domain Expertise

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?

What is your process for troubleshooting a critical system failure in a production environment?

Medium · Technical & Domain Expertise

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 North East Medical Services candidates report.

Day 1 — Map the North East Medical Services loop

Write out the reported sequence: Experience Review, Technical Deep Dives, 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 3 reported rounds, with the weakest marked.

Day 2 — Work EPIC EHR Applications (Epic Application Analyst)

Spend the session on EPIC EHR Applications (Epic Application Analyst), which North East Medical Services candidates report being tested on.
Write one worked example in EPIC EHR Applications (Epic Application Analyst) and time yourself on it.

Deliverable: One timed worked example in EPIC EHR Applications (Epic Application Analyst).

Day 3 — Work Risk Adjustment (HCC)

Spend the session on Risk Adjustment (HCC), which North East Medical Services candidates report being tested on.
Write one worked example in Risk Adjustment (HCC) and time yourself on it.

Deliverable: One timed worked example in Risk Adjustment (HCC).

Day 4 — Work Health Coding / Medical Coding

Spend the session on Health Coding / Medical Coding, which North East Medical Services candidates report being tested on.
Write one worked example in Health Coding / Medical Coding and time yourself on it.

Deliverable: One timed worked example in Health Coding / Medical Coding.

Day 5 — Answer out loud: Technical & Domain Expertise

Answer aloud, timed: How have you optimized a database or system for better performance in a high-volume environment?
Answer aloud, timed: Describe your experience integrating third-party software with existing clinical or administrative workflows.

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

Day 6 — Answer out loud: Behavioral & Situational

Answer aloud, timed: Tell us about a time you had to explain a complex technical issue to a non-technical stakeholder.
Answer aloud, timed: Describe a situation where you had to balance competing priorities under a tight deadline.

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

Day 7 — Dry run for North East Medical Services

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 integrating third-party software with existing clinical or administrative workflows.

Medium · Technical & Domain Expertise

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?