Fractional Chief Financial Officer (CFO)

The Fractional CFO provides part-time executive financial leadership for a municipal non-profit ambulance organization. This role is responsible for ensuring financial sustainability, regulatory compliance, and strategic alignment with the organization's mission to deliver high-quality emergency medical services (EMS) to the community. The Fractional CFO works closely with executive leadership, municipal stakeholders, and the governing board to manage public funds responsibly, optimize reimbursement revenue, and support long-term operational viability.

Key Responsibilities

Financial Strategy & Municipal Alignment

• Develop & implement financial strategies aligned with the organization's mission and municipal expectations
• Advise leadership on financial implications of service expansion, staffing models, and capital investments (e.g. ambulances, equipment)
• Support long-term financial planning, including sustainability of EMS operations in a public/non-profit context

Budgeting, Forecasting & Fund Accounting

• Lead development of annual operating and capital budgets
• Monitor budget-to-actual performance and provide variance analysis
• Oversee fund accounting practices, including restricted and unrestricted funds
• Assist in financial reporting required by municipal partners and governing bodies

Revenue Cycle & Reimbursement Optimization

• Oversee EMS billing and collections processes, including Medicare, Medicaid, and private insurance reimbursements
• Analyze payer mix and reimbursement trends to identify revenue improvement opportunities
• Ensure compliance with healthcare billing regulations and documentation requirements
• Collaborate with billing vendors or internal staff to improve revenue cycle efficiency

Cash Flow & Financial Sustainability

• Monitor cash flow, liquidity, and reserve levels
• Develop strategies to manage fluctuations in reimbursement timing and funding cycles
• Provide recommendations for maintaining adequate operating reserves

Grants, Funding & Compliance

• Support identification, application, and management of grants (local, state, and federal)
• Ensure proper tracking and reporting of grant funds in accordance with requirements
• Assist with compliance related to municipal funding, contracts and intergovernmental agreements

Accounting Oversight & Audit Coordination

• Oversee accounting functions to ensure accuracy and compliance with GAAP for non-profits
• Prepare and review financial statements and board reports
• Coordinate annual audits and serve as liaison with external auditors
• Ensure timely filing of required reports (e.g. IRS Form 990, state filings)

Risk Management & Internal Controls

• Establish and maintain internal financial controls to safeguard public funds
• Identify financial risks related to operations, reimbursement, or funding sources
• Ensure compliance with applicable regulations, including healthcare and municipal requirements

System & Operational Efficiency

• Evaluate financial systems, billing platforms, and reporting tools
• Recommend and implement improvements to enhance efficiency and transparency
• Support data-driven decision-making through KPI development (e.g. cost per transport, collection rates, unit hour utilization)

Stakeholder Communication

• Present financial reports and strategic insights to executive leadership, board members, and municipal officials.
• Translate complex financial data into clear, actionable information for non-financial stakeholders
• Support transparency and accountability in public-facing financial reporting

Qualifications

• Bachelor's degree in Finance, Accounting, or related field (CPA strongly preferred)
• 10+ years of financial leadership experience, preferably in non-profit, healthcare, EMS or municipal environments
• Strong knowledge of non-profit accounting standards and fund acounting
• Experience with healthcare reimbursement systems (Medicare/Medicaid) highly preferred
• Familiarity with grant management and public funding structures
• Proven experience working with boards, government entities, or public agencies

Key Skills & Competencies

• Strategic financial leadership in mission-driven organizations
• Deep understanding of EMS or healthcare financial dynamics
• Strong analytical and forecasting capabilities
• Excellent communications skills for diverse stakeholders
• High level of integrity and commitment to public stewardship
• Ability to navigate regulatory and compliance requirements

Work Structure

• Part-time/contract/retainer-based role
• Flexible schedule based on organizational needs and reporting cycles
• May be remote with periodic on-site or board meeting attendance
• Expected to engage regularly with leadership and key stakeholders

Typical Deliverables

• Monthly financial statements and board reports
• Annual operating and capital budgets
• Cash flow projections and sustainability plans
• Grant financial reports and compliance documentation
• Revenue cycle performance analysis
• Other tasks as assigned by the Director