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 logicAllowed modifier combinationsMissing / invalid diagnosis or procedure codesDuplicate detectionNon-payment encountersBuild 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 / MORStrong 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 + equityHybrid / remote flexibilityDirect impact on a new enterprise productWork in a high-growth, award-winning AI healthtech company (TiE50, AWS Bedrock partner)