Chief Operating Financial Officer

‍Role Overview

This role is focused on building durable financial and operational structure, improving visibility into performance, and implementing systems that allow the practice to scale efficiently and operate predictably.

This is not a traditional practice manager or office administrator role. The ideal candidate has previously served as a CFO, COO, or CFO/COO hybrid, and has experience architecting systems, cadence, and accountability in complex organizations.

Primary Mandate

The Fractional CFO / COO will function as the practice’s architect and integrator, responsible for:

• Designing and implementing financial and operational infrastructure
• Creating clarity and visibility into performance across service lines
• Establishing operating cadence, dashboards, and accountability systems
• Partnering directly with the physician-owner on prioritization and strategic decisions

Key Responsibilities

‍Financial Leadership

• Establish clean, actionable financial reporting (P&L, cash flow, AR, service-line profitability)
• Improve collections velocity, AR aging, and cash discipline
• Analyze overhead, staffing ratios, and vendor contracts to optimize margins
• Build budgeting, forecasting, and variance-tracking processes
• Support MSO-style structuring and inter-entity clarity where applicable

Operational Leadership

• Design and implement SOPs across administrative and clinical support functions
• Establish KPIs, dashboards, and weekly/monthly operating cadence
• Identify operational bottlenecks and inefficiencies; drive resolution
• Improve cross-department coordination (front desk, billing, clinical ops, ancillary services)
• Ensure leadership accountability and decision clarity

Strategic Partnership

• Act as a trusted #2 to the physician-owner
• Translate strategy into execution with clear priorities
• Build a structure that allows the practice to operate effectively with reduced owner dependency
• Develop a transition plan for long-term sustainability

Ideal Candidate Profile

• 10+ years experience in CFO, COO, or combined leadership roles
• Demonstrated success building systems, structure, and financial discipline
• Experience in healthcare, professional services, or other complex regulated environments strongly preferred
• Comfortable operating in founder-led or physician-led organizations
• Strong financial acumen (P&L, AR, cash flow, margin analysis)
• Hands-on operator who can both design and implement
• Willing and able to be on-site in El Paso initially (hybrid long-term)

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How to Apply

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