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Senior Encounter Submissions Software Engineer / Analyst

Senior Encounter Submissions Software Engineer / Analyst

Invent Healthshimoga, India
1 day ago
Job description

Invent Health Inc. — Silicon Valley, CA (Remote / Hybrid)

Full-Time | Encounter Data | Medicaid, MA, ACA | Databricks | EMR / EDI Integrations

Invent Health is a fast-growing AI-driven healthcare analytics company processing  5.5M+ member lives  across Medicare Advantage, Medicaid (MCP / Medi-Cal), and ACA plans. Known for industry-leading NLP accuracy (85–90%), encounter reconciliation, and enterprise-grade interoperability, we are now expanding into a  next-generation Encounter Submissions System  — fully integrated with our Modular Analytics Platform (MAP) and Databricks-powered data ecosystem.

We are looking for a  Senior Encounter Submissions Software Engineer / Analyst  who will  design, architect, and build the new IH Encounter Submissions engine , including validation, reconciliation, error correction workflows, and payer-ready outbound formats across MA, Medicaid, and ACA.

What You Will Build (Core Responsibilities) 1. Architect Invent Health’s new Encounter Submissions System

  • Design the end-to-end encounter pipeline supporting MA, Medicaid, and ACA encounter standards.
  • Map and manage records across  837 ,  277 / 278 ,  999 ,  TA1 ,  MAO-002 ,  MAO-004 ,  MMR / MOR , and Medicaid T-MSIS / T-XIX formats.
  • Build automated validation rules (CMS, State, DNSP, plan-specific edits).
  • Implement logic for sequencing, batching, routing, acknowledgements, and error tracking.

2. Build a scalable, cloud-native ETL & validation pipeline

  • Design Databricks or Spark-based transformations for inbound / outbound encounters.
  • Build crosswalks between claims, encounters, provider data, member data, and IH’s internal linked records.
  • Own schema evolution, versioning, and pipeline observability.
  • 3. Create Error Correction & Workflow Tools

  • Define and implement the rules for :
  • FQHC / RHC logic
  • Allowed modifier combinations
  • Missing / invalid diagnosis or procedure codes
  • Duplicate detection
  • Non-payment encounters
  • Build dashboards for QA teams and plan analysts to triage and fix errors.
  • 4. Integrate with Invent Health modules

  • Build consistent linking with MAP : risk adjustment, coding, quality, ACA XML, CDU, IHA, and NLP workbench.
  • Expose encounter health metrics into RAF, Risk Analytics, and provider dashboards.
  • 5. Compliance, Testing & Deployment

  • Ensure all formats adhere to CMS / state regulations.
  • Implement automated regression testing across multiple plan templates.
  • Work with client engineering teams to support plan onboarding.
  • Required Experience

    You should have  5–10+ years  of hands-on experience in the following :

    Encounter Data Expertise

  • Deep knowledge of  Medicare Advantage Encounter Data  (MAOs), especially :
  • MAO-002 (Submission Status)
  • MAO-004 (Risk Score / Diagnosis Deletion)
  • MMR / MOR
  • Strong understanding of  Medicaid encounters , including T-MSIS and state-specific rules.
  • Prior experience building or maintaining  Encounter Submission engines  or EDI systems.
  • Technical Skills

  • Strong SQL + Python; Spark / Databricks experience preferred.
  • Familiarity with AWS, Delta Lake, ETL orchestration.
  • EDI parsing (837P / I / D), X12 standards, schema validators.
  • Experience with multi-source clinical / claims data.
  • Nice-to-Have

  • Experience working with health plans, TPAs, or vendors like Cotiviti, Edifecs, Change Healthcare, etc.
  • Knowledge of provider data, coding workflows, NLP-based coding, risk adjustment operations.
  • What Makes This Role Special

    This is not a maintenance role — this is a  build-from-scratch, greenfield system  that becomes a  core Invent Health product module  used by top Medicaid and MAO clients.

    You will :

  • Lead architecture & design decisions.
  • Influence product roadmap.
  • Work directly with Invent Health’s CEO, engineering, and analytics leaders.
  • Own a system that will scale across millions of encounters each month.
  • Benefits

  • Competitive salary + equity
  • Hybrid / remote flexibility
  • Direct impact on a new enterprise product
  • Work in a high-growth, award-winning AI healthtech company (TiE50, AWS Bedrock partner)
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