Senior Encounter Submissions Software Engineer / Analyst

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)