Alpaca Health enables clinicians to become entrepreneurs, starting in autism care.
We help clinicians launch and scale their own clinics by providing AI-powered software, payer contracting, and full back-office infrastructure. Our goal is simple: shift power in healthcare away from large consolidated entities and back to clinicians.
We've raised over $14M in funding from early-stage investors like Core Innovation Capital, Adverb Ventures, and South Park Commons, and are building for long-term category leadership. More importantly, we're serving hundreds of patients, while growing 30% MoM.
This role is full-time. We’re looking for candidates remotely. We also have an New York City and San Francisco office.
About the Role
Payroll is the part of our product people notice most when it goes wrong. Our customers are clinic owners whose RBTs and BCBAs depend on them for a correct paycheck every two weeks. You'll own that outcome — running payroll across dozens of clinics in multiple states, and owning the Salsa-based platform it runs on: configuring it, catching problems early, and telling engineering what needs to change.
You'll be the person clinic owners email when something's wrong, and the person inside Alpaca who knows payroll best. There's no playbook yet — you'll write it.
What You'll Do
1. Run payroll, end to end
Own the full biweekly cycle per employer: pre-run verification, timesheet reconciliation, approvals, funding, submission, and post-run checks.
Handle off-cycle runs, retro pay, overtime corrections, terminations, garnishments, and other adjustments.
Reconcile Alpaca's data against Salsa, and build checks that catch errors before a customer does.
2. Own the payroll platform (built on Salsa)
Know our Salsa-powered infrastructure better than anyone at Alpaca; configure new clinics and employees.
Diagnose issues to root cause, triage customer question vs. config problem vs. bug, and write clear tickets for engineering.
Push for platform changes that eliminate recurring manual work.
3. Onboarding & multi-state compliance
Run white-glove employer onboarding: state tax ID registrations, TPA access grants, data migration, and LLC incorporation support.
Guide employers through worker onboarding and HR paperwork (I-9s, new-hire reporting), following up so nothing blocks payroll.
Manage quarterly/annual filings, resolve tax notices and Salsa webhook escalations proactively, and stay current on state tax, leave, and wage-notice rules.
Set up PTO/leave policies and manage state auto-IRA and 401(k) contributions.
4. Support clinic owners directly
Be the frontline for payroll support — the human on the other end of a stressful email.
Explain what happened, what you're doing about it, and when it'll be fixed.
Escalate systemic issues to engineering with clear repro steps and impact.
5. Build the systems that make this scale
Document workflows and edge cases; build the checklists and templates that keep cycles predictable.
Keep SOPs and knowledge base articles current, and use automation to turn recurring escalations into product fixes.
Who You Are
Ambitious, fast-moving, and comfortable with high accountability and little structure.
AI-native — you already use tools like Claude Code or Cursor to build and prototype.
A systems thinker who turns chaos into repeatable process, and can juggle many priorities without dropping details.
Direct exposure to company-building at an early stage.
Real ownership of critical initiatives from day one.
The opportunity to materially impact families and clinicians.
A fast learning curve that few roles can match.
Strong compensation package
💵 Competitive salary
📈 Meaningful equity
🏥 Health benefits
🏖️ Flexible PTO
🍱 Dinner when working late