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)