Chief Financial Officer

Job Summary:

Administers, directs, and monitors all hospital financial activities and keeps the Chief Executive Officer and the hospital Board of Directors informed of the financial condition of the hospital. This position is responsible for safeguarding hospital assets, optimizing rural revenue cycle performance, and ensuring compliance with all state and federal regulations—including Texas Health and Human Services (HHS) guidelines and Centers for Medicare & Medicaid Services (CMS) Conditions of Participation. The position requires availability or delegated availability to respond after working hours and to take rotational call.

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Supervisory Responsibilities:

• Accounting, Accounts Payable, Materials Management, HIM, Revenue Cycle, Patient Access

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Duties/Responsibilities:

• Develop, direct, and lead activities so that all financial functions are conducted in an efficient and effective manner.
• Manage internal and external audits, tax filings, and general accounting practices.
• Maintain departmental productivity measures; report status monthly.
• Direct and participate in the development of accounting and internal control policies and systems.
• Develop and implement department policies and procedures that reflect the organization’s standards.
• Develop a hospital budget within designated deadlines according to all budgetary policies and procedures.
• Effectively utilize resources within an established budget and notify the CEO of all variances anticipated or accrued, to maintain department services.
• Participate in the hospital’s long-and-short term financial planning process.           
• Recommend ways to reduce expenditures and enhance revenues without compromising quality of services.
• Ensure proper and timely payment of Payroll/payroll taxes.
• Review and approve monthly balance sheet account analysis. 
• Ensure proper classification and integrity of the account balances.
• Demonstrate competence in performance in preparing and analyzing financial reports according to hospital policy and procedures.
• Provide advice and guidance as necessary in preparing and analyzing financial reports and executing appropriate responsive actions.
• Provide timely, accurate, and clear financial reports to the CEO and Board of Directors.
• Properly perform and utilize EMR financial modules and any applicable systems required.   
• Assist in evaluating the adequacy of the hospital insurance coverage and in handling special /sensitive cases or problems and providing advice and guidance as necessary in preparing and analyzing risk management, insurance reports, and appropriate executive responsive actions.
• Recommend appropriate actions and strategies to respond to projected economic trends and/or regulatory changes and to facilitate the achievement of established financial objectives. Advise the CEO of financial trends.
• Participate in the analysis of financial implications of proposed capital projects and expenditures and recommend the execution of appropriate measures to respond to projected economic trends and/or regulatory changes.    
• Direct and participate in the preparation of the budgets for the general accounting, financial services, controller’s office, and affiliated accounting departments; review and analyze the budget performance and identified variances; ensure effective cost control.
• Ensure that accurate information is provided on a timely basis and assists as needed in facilitating the efficient conduct of external audits, examinations, and related financial projects.
• Cash Flow & Liquidity Optimization: Monitor daily cash positions to ensure steady liquidity, compensating for volatile Medicaid/Medicare cost-settlement timelines.
• Tax District Fund Custody: Manage tax revenues generated by the local Hospital District, allocating funds efficiently between operational reserves and capital debt service.
• Debt and Credit Facility Management: Direct short-term and long-term financing strategies, maintaining line-of-credit structures with lending institutions.
• Investment Portfolio Management: Invest surplus operational cash into safe, short-term instruments in compliance with public fund investment acts
• Grant Allocation Compliance: Track and report state-level funding streams, including the HHSC Rural Hospital Innovation Grant Program
• Ensure all grant funds are properly documented to prevent clawbacks during annual CMS Cost Report audits.
• Cost-Based Reimbursement: Oversee specialized CMS cost reporting to maximize Medicare cost-based reimbursement structures.
• Swing-Bed Strategy: Drive the financial strategy and accurate billing for "swing-bed" (post-hospital skilled nursing) services to leverage the hospital’s 25-bed capacity.
• Cross-Functional Staffing Support: Navigate the unique challenge of lean rural staffing by equipping revenue cycle and patient access teams to handle multiple cross-functional responsibilities seamlessly.
• Front-End Optimization: Standardize patient scheduling, insurance pre-authorization, and front-end registration workflows to stop denial leaks before care is delivered.
• Denial & A/R Management: Actively monitor key financial performance indicators—specifically reducing Days Sales Outstanding (DSO), minimizing aging Accounts Receivable (A/R > 90 days), and auditing root causes of claim denials.
• Ensure that the pharmacy cleanly separates 340B drug costs from standard cost-report filings to avoid "double-dipping" allocations. 
• Monitor, administer, and advise the Admin team on all government supplemental programs such as DSH, Uncompensated Care, Upper Payment Limit Programs, and new programs as they are developed.
• Ensure a strong GPO contract is in place.
• Assist Rural Health Clinic in:
•  aligning productivity metrics and operating workflows with overall hospital system budgets, revenue strategies, and practices;
•  ACO financial modeling, shared savings distribution, risk-sharing arrangements, and quality metric tracking tied to value-based reimbursement; and
•  timely enrollment of physicians and mid-level providers (NPs/PAs) with Medicare, Medicaid, and commercial insurance plans to prevent billing delays and ensure no lapses in enrollment.
• Responsible for accuracy of department payroll, including approval via HRIS platform.  
• Conduct regular leadership rounding in clinical and administrative units.
• Perform other related duties to benefit the mission of the organization. 

Required Skills/Abilities: 

• Excellent command / highly proficient in spoken and written English.
• Advanced computer skills, including but not limited to: Microsoft Office, information security, scheduling and payroll systems, and email.
• Must be effective at adjusting to change, prioritizing duties, handling stress, and effectively communicating face-to-face and/or over the telephone.
• Ability to work independently and flexibly, and as a part of a multidisciplinary team.
• Ability to manage several interruptions throughout the day.
• Strong interpersonal and communication skills, verbal, written, and presentation.
• Strong time management skills.
• Must be able to work under pressure while interacting in a helpful, courteous manner.
• Demonstrate skill in translating complex fiscal data into plain terms for non-financial clinical staff and Board.
• Ability to mentor small, multi-functional teams.

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Job-related Skills and Abilities: 

• Capacity to forecast financial volatility, audit internal controls, and protect thin operating margins.
• Ability to manage fund accounting and million-dollar federal/state healthcare grants.
• Strong knowledge of public fund treasury practices, local tax levies, and debt compliance.
• Proficiency with grant-tracking modules within hospital accounting systems.
• Reimbursement Expertise: Mastery of Medicare cost reports, swing-bed rules, and specialized CAH cost-based payment systems.
• Revenue Cycle Management: Skills to optimize billing, coding, collections, and cash flow in a low-volume setting.
• Grant & Funding Acumen: Ability to source, track, and manage federal grants, state funding, and community philanthropy.
• Software Proficiency: Advanced command of hospital ERP systems, electronic health record (EHR) financial modules, and budget modeling tools.
• Commitment to quality and patient safety at all times.

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Education and Experience:

• Bachelor’s degree required. Master’s degree in healthcare administration, business, or related field preferred.
• Five years of directly related experience in a hospital senior management role required.

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Physical and Mental Requirements: 

• Combination of sitting, standing, and walking throughout the workday
• Occasional bending, reaching, kneeling, and lifting
• Ability to lift and carry up to 30 pounds as needed
• Frequent use of hands and fingers for computer and equipment use
• Ability to navigate all areas of the facility
• Sufficient hearing, vision, and dexterity to perform duties safely
• Stress Level: Moderate to High

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OSHA Classification:

Category III: Tasks that involve no exposure to blood, body fluids, or tissues, and Category I tasks are not a condition of employment.

• The normal work routine involves no exposure to blood, body fluids, or tissues (although situations can be imagined or hypothesized under which anyone, anywhere might encounter potential exposure to body fluids). Persons who perform these duties are not called upon as part of their employment to perform or assist in emergency medical care or first-aid or to be potentially exposed in some other way. Tasks that involve handling implements or utensils, use of public or shared bathroom facilities or telephone, and personal contacts such as handshaking are Category III tasks.