Senior Encounter Submissions Software Engineer

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)