Fractional Controller for 15+ Outpatient Clinics and Grants Contract Part Time

About the Organization

The Foundation for Sickle Cell Disease Research is a growing nonprofit healthcare organization supporting a network of 15+ outpatient clinic locations, grant-funded initiatives, patient-service operations, and related programs.

As the organization continues to grow, we are building a more sophisticated finance function capable of delivering accurate, timely and decision-useful reporting across clinics, grants, programs and revenue streams.

Position Summary

FSCDR is seeking an experienced, hands-on Fractional Controller to build, organize and oversee the organization’s financial management infrastructure.

This is not a passive advisory position and is not limited to bookkeeping, tax preparation or reviewing reports created by others. The selected contractor must be comfortable working directly in the financial systems, diagnosing weaknesses, cleaning up processes, building reports and translating financial information into clear recommendations for executive leadership.

The Fractional Controller will be responsible for establishing reliable monthly financial reporting, cash-flow forecasting, clinic-level financial analysis, budget-to-actual reporting, grant oversight, payroll allocation controls and reconciliation between patient-service revenue, billing activity, and the general ledger.

The ideal candidate understands the operational realities of a growing nonprofit healthcare organization and can create structure without unnecessarily overcomplicating the organization’s systems.

Primary Responsibilities

• Financial Reporting and Monthly Close
• Review and strengthen the organization’s chart of accounts, accounting workflows and financial reporting structure.
• Establish and manage a consistent monthly closing process.
• Ensure key accounts are reconciled accurately and timely.
• Produce consolidated and entity-level financial statements.
• Prepare monthly budget-versus-actual reports and explain significant variances.
• Identify accounting errors, unsupported balances, duplicate transactions, misclassifications and incomplete reconciliations.
• Coordinate with the organization’s CPA regarding tax filings, year-end accounting, audit support and other external reporting needs.
• Cash Management and Financial Planning
• Develop and maintain a rolling 13-week cash-flow forecast.
• Provide leadership with a clear schedule of obligations due within the next 7, 30, 60 and 90 days.
• Distinguish restricted grant funds from unrestricted operating cash.
• Monitor upcoming payroll, payroll tax, vendor, lease and other major obligations.
• Develop annual operating budgets, departmental budgets, and rolling financial forecasts.
• Identify potential cash shortages, timing issues and other financial risks before they become emergencies.
• Provide leadership with concise recommendations regarding payment priorities and available operating cash.
• Clinic and Location-Level Financial Management
• Design and implement financial reporting for 15+ outpatient clinic locations.
• Produce clinic-level profit-and-loss or contribution-margin reports.
• Track revenue, payroll, medical supplies, rent, occupancy, local operating costs and other direct expenses by clinic.
• Establish a reasonable and documented methodology for allocating shared and corporate expenses.
• Help leadership understand each location’s financial standing (cost versus revenue)
• Develop key financial indicators for clinic performance and sustainability.
• Work with operations leadership to investigate significant clinic-level variances.
• Payroll and Cost Allocation
• Review ADP departments, locations, labor allocations and employee coding.
• Ensure employees are assigned to the correct clinic, department, grant, program or administrative function.
• Create a process for allocating employees who work across multiple clinics, grants or departments.
• Reconcile payroll reports to QuickBooks and applicable grant reports.
• Work with Human Resources and operations leadership to correct payroll coding and maintain accurate assignments going forward.
• Establish controls for payroll changes and financial review of new positions.
• Grant Financial Oversight
• Provide senior-level oversight of the organization’s grant accounting and grant financial reporting processes.
• Review grant budgets, expenditures, reimbursement requests, invoices and financial reports prepared by the Grant Accountant.
• Ensure grant expenses are recorded in the appropriate period, account, location and funding source.
• Monitor grant budget utilization, reimbursement timing, outstanding receivables and potential compliance concerns.
• Establish cost-allocation and indirect-cost methodologies where applicable.
• Coordinate with program leadership to address financial variances, documentation gaps and spending concerns.
• Help ensure grant records are organized and supportable for monitoring visits, audits and closeout.
• Revenue-Cycle Financial Reconciliation
• Work collaboratively with the Senior Revenue Cycle Manager without taking over claims, coding or denial-management functions.
• Identify material discrepancies between billing-system data, payment posting, and accounting records.
• Produce financial summaries that allow leadership to understand revenue performance by clinic, payer, service line or other meaningful category.
• Internal Controls and Financial Procedures
• Evaluate the organization’s current financial controls and recommend practical improvements.
• Establish written procedures for vendor setup and invoice uploads, invoice approval, payment authorization, expense reimbursement, credit card use, and accounting adjustments.
• Develop appropriate separation of duties within a lean finance structure.
• Maintain the principle that no single individual should independently create a vendor, approve an invoice, release payment and reconcile the same transaction.
• Support secure handling of confidential financial, payroll, employee and healthcare-related information.
• Help create an audit-ready financial environment.
• First 90-Day Deliverables
• By the end of the first 30 days, the contractor will deliver:
• Financial Diagnostic
• A clear assessment of:
• Current condition of the books
• Status of bank and balance-sheet reconciliations
• Chart-of-accounts weaknesses
• Payroll coding issues
• Grant accounting issues
• Accounts payable and accounts receivable visibility
• Cash-management risks
• Clinic reporting limitations
• Internal control weaknesses
• Significant cleanup priorities
• Complete Financial Inventory
• An organized inventory of:
• Legal entities and QuickBooks files
• Bank and credit card accounts
• Clinic locations
• Major departments and programs
• Active grants
• Revenue streams
• Major recurring obligations
• Existing financial reports
• Key accounting and payroll system users
• The forecast must show:
• Current cash by account or entity
• Restricted versus unrestricted funds
• Expected patient-service collections
• Expected grant receipts
• Payroll and payroll-tax obligations
• Bills and contractual payments due
• Potential cash shortfalls
• Leadership decisions required
• 7-, 30-, 60- and 90-Day Obligations Schedule
• A working schedule of known upcoming payments, including major vendors, payroll, taxes, leases, contracts and other recurring obligations.
• By the end of day 60, the contractor will deliver:
• Standardized Financial Coding Structure
• A documented structure for consistently identifying transactions by:
• Legal entity
• Clinic or location
• Department or service line
• Grant or funding source
• Restricted or unrestricted status
• Direct or shared expense
• Revenue category
• QuickBooks and ADP Coding Map – A written crosswalk showing how QuickBooks accounts, classes, locations, projects or other identifiers correspond with ADP departments, locations and payroll allocations.
• Initial Clinic-Level Financial Reports – A first complete draft of clinic-level financial reporting for all active locations, with any known data limitations or allocation assumptions clearly disclosed.
• Initial Monthly Management Package – The first management package should include:
• Organization-wide profit and loss
• Balance sheet
• Cash position
• Budget versus actual
• Accounts payable
• Accounts receivable
• Clinic-level results
• Grant financial status
• Significant variances
• Written executive summary
• Revenue-Cycle Reconciliation Prototype – A documented reconciliation for at least one recent reporting period connecting billing activity, expected collections, payments posted, deposits and general-ledger revenue.
• Internal Control Matrix – A written matrix showing who may:
• Add or modify vendors
• Enter bills
• Approve expenses
• Release payments
• Record journal entries
• Reconcile accounts
• Review financial statements
• Approve payroll changes
• Annual Budget and Forecast Framework – A standardized budget template for clinics, programs, grants, corporate operations and consolidated organizational reporting.
• Days 61–90: Establish a Reliable Recurring Finance Function
• By the end of day 90, the contractor will deliver:
• Reliable Monthly Close – The organization should have a repeatable process designed to close the books and issue management reports by approximately the tenth business day following month-end.
• Complete Monthly Management Reporting Package – The recurring package must include:
• Consolidated and entity-level financial statements
• Cash-flow forecast
• Budget-versus-actual reporting
• Accounts payable aging
• Accounts receivable aging
• Grant receivables
• Clinic-level financial results
• Grant budget utilization
• Revenue-cycle reconciliation
• Written variance analysis
• Executive recommendations
• Clinic Financial Performance Framework – Each clinic should have a consistent report showing, to the extent supported by available data:
• Patient-service revenue
• Grant or program revenue
• Direct clinical payroll
• Direct administrative payroll
• Medical and infusion supplies
• Rent and occupancy
• Local operating expenses
• Direct contribution margin
• Allocated shared expenses
• Final operating result
• Updated Rolling Forecast – A forward-looking financial forecast incorporating expected revenue, expenses, payroll, grant activity and known organizational commitments.
• Written Financial Policies and Procedures – Initial documented procedures covering the most important recurring financial activities, approvals and controls.
• Leadership Risk and Opportunity Report – A written report identifying:
• Locations requiring financial intervention
• Grant spending concerns
• Cash-flow risks
• Significant receivables
• Potential expense reductions
• Reporting deficiencies
• Areas requiring further investment or staffing.

Minimum Qualifications

• Bachelor’s degree in accounting, finance or a related field.
• At least 7–10 years of progressive accounting and financial-management experience.
• Prior experience as a Controller, Assistant Controller, Director of Finance, Accounting Manager or equivalent.
• Demonstrated experience with nonprofit accounting and restricted funding.
• Experience managing or overseeing grant financial reporting.
• Strong knowledge of generally accepted accounting principles.
• Experience producing monthly financial statements, budgets, forecasts and cash-flow models.
• Advanced QuickBooks Online and Microsoft Excel proficiency.
• Experience with ADP or a comparable payroll system.
• Ability to build financial reporting by clinic, location, program, department or business unit.
• Strong balance-sheet reconciliation and month-end close experience.
• Ability to communicate complicated financial information clearly to non-financial executives.
• Strong judgment, confidentiality and attention to detail.

Preferred Qualifications

• CPA or CMA designation.
• Healthcare, physician-practice, outpatient-clinic or medical-group experience.
• Experience reconciling patient-service revenue or medical billing reports to accounting records.
• Federal, state or other government grant experience.
• Experience with multi-entity or multi-location organizations.
• Prior experience building a finance function in a rapidly growing organization.
• Experience preparing financial reports for boards, grantors, auditors and executive leadership.

Important Role Boundaries

• This role does not replace the organization’s CPA for tax filings and other specialized tax matters.
• This role does not own medical coding, claim submission, denial management or insurance follow-up.
• This role will not have authority to release payments.
• This is a hands-on engagement; applicants seeking only a high-level advisory role should not apply.

Compensation

$ 70 – $ 75 per hour

Tagged as: cash management, Financial Reporting, Grant Oversight, Nonprofit Accounting, Payroll