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  5.5 M+ 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 (837 P/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 (Ti E50, AWS Bedrock partner)