Senior Encounter Submissions Software Engineer

Invent Health Inc. — Silicon Valley, CA (Remote/Hybrid)Full-Time | Encounter Data | Medicaid, MA, ACA | Databricks | EMR/EDI IntegrationsInvent 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 SystemDesign 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 pipelineDesign 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 ToolsDefine 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 modulesBuild 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 & DeploymentEnsure 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 ExperienceYou should have 5–10+ years of hands-on experience in the following:Encounter Data ExpertiseDeep 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 SkillsStrong 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-HaveExperience 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 SpecialThis 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.BenefitsCompetitive salary + equityHybrid/remote flexibilityDirect impact on a new enterprise productWork in a high-growth, award-winning AI healthtech company (TiE50, AWS Bedrock partner)