Your finance lead just left. Here is what breaks first.
An interim CFO exists to stop a staffing problem from becoming a cash problem. Most of the damage in a finance transition happens in the first two weeks, and almost none of it is strategic. It is access, deadlines, and the things only one person knew.
Transition triage
Tell it who is leaving and what applies to you. It returns the order to work in, based on when each consequence actually lands. No email required and nothing is sent anywhere.
Who is leaving
Where you are
What applies to you
Your sequence
11 items, ordered by when the consequence lands rather than by effort.
- 01
Inventory every credential that person holds and get a second administrator on each one
Bank portals, payer portals, the payroll system, state tax accounts, the clearinghouse, and the practice management system. In most practices one person holds all of it and no one else has admin rights. Do this before the last day, not after.
- 02
Find out what lives only on their machine
The cash forecast, the payer fee schedule spreadsheet, the reconciliation workbook, the file of undocumented adjustments. Institutional knowledge in a clinic finance function is usually a handful of spreadsheets nobody else has opened.
- 03
Confirm your PEO or payroll provider has a named contact who is not the person leaving
Providers will refuse instructions from someone not on the authorised list, which surfaces at the worst possible moment.
- 01
Re-establish payment approval and check-signing authority
If the departing person approved or released payments, you now have either a bottleneck or, worse, a single remaining person who can both create and release a payment. Separating those two duties is the control that matters most.
- 02
Pull your loan agreement and diary every reporting date and covenant test
Covenant reporting is contractual and dated. A missed submission can be a technical default on its own, independent of whether you are actually performing. Lenders are usually reasonable if you call before the date rather than after.
- 03
Tell your lender there has been a change in finance leadership
They will find out. Telling them first, with a plan attached, is a materially different conversation from being asked.
- 04
Set a date for the next monthly close and name who owns each step
Close slips quietly. One skipped month is recoverable; three is a reconstruction project, and it is always discovered at the point you most need current numbers.
- 01
Check who is watching denials, AR aging, and payer credentialing dates
These are usually monitored rather than owned, so they fall through a transition without anyone noticing for a full cycle. Credentialing and revalidation deadlines in particular do not forgive being missed.
- 02
Rebuild a rolling 13-week cash forecast
It is the first thing to disappear when a finance lead leaves and the first thing you need when you have to make a decision without one. Thirteen weeks is short enough to be accurate and long enough to see a problem coming.
- 01
Decide what you are actually replacing before you write a job description
Most practices post a copy of the departing person's title. The role that left is frequently not the role you now need, particularly if it grew by accretion rather than design.
- 02
Document the processes as they are rebuilt, while they are still unfamiliar
This is the only moment when the gaps are visible. Six months from now the new arrangement will feel normal and will be just as undocumented as the old one.
This is a sequencing aid, not advice on your specific situation. It deliberately contains no cost or loss estimates, because those depend on numbers only you have. If you want the triage run against your actual books, talk to us.
Interim, fractional, or a full-time hire
These get used interchangeably and they are not the same engagement. The distinction is not hours. It is whether the seat existed before.
An interim CFO fills a seat that is empty. There is a defined end: a permanent hire, a transaction closing, a system migration finishing. The work is continuity, and it is heaviest at the start.
A fractional CFO fills a seat that never existed. A $6M clinic group rarely justifies a full-time CFO salary but still has to price payer contracts, model a second location, and decide whether the numbers support an exit. That need does not end, so neither does the engagement.
A full-time hire makes sense once the finance function is large enough to manage. If you are hiring one mainly because the last one left, that is worth examining before you post the role. The job that just ended is frequently not the job you now need.
If the question is cost rather than fit, the CFO cost comparison tool sets out the loaded-cost framework, including the parts of a permanent hire that do not appear in the salary line.
What an interim engagement covers here
We start with the calendar, not the strategy. Dated obligations first: payroll tax deposits, lender reporting, filing deadlines, credentialing and revalidation dates. Those carry consequences that do not care why the seat is empty.
Then the close. Getting the monthly close running again is what restores your ability to make any decision at all, and it is usually where the previous arrangement turns out to have been held together by one undocumented spreadsheet.
Then the forward view. A rolling 13-week cash forecast is the first thing to disappear in a transition and the first thing you need back. After that, the work becomes ordinary fractional CFO work, or it hands over cleanly to whoever you hire.
We work with outpatient clinic groups, so the payer mechanics are not new to us. If part of what the departing person held was the revenue cycle, the question of whether to outsource it tends to arrive in the same month, and it is worth answering deliberately rather than under pressure.
Common questions
What is the difference between an interim CFO and a fractional CFO?+
An interim CFO fills a seat that is empty. The engagement is full-time or close to it, defined by an end date or a hire, and the job is continuity: keep the close running, keep the lender informed, keep payroll and filings on time. A fractional CFO fills a seat that never existed. The engagement is part-time and ongoing, and the job is judgment the practice has never had in-house. Interim is a gap. Fractional is a permanent arrangement at a fraction of the time.
When does a clinic need an interim CFO rather than just a bookkeeper?+
It depends on what the departing person actually did rather than their title. If they reconciled accounts and ran payroll, a bookkeeper or an outsourced accounting team can cover it. If they also produced lender reporting, held the cash forecast, priced payer contracts, or answered to a board or a buyer, those are not bookkeeping tasks and they will not be picked up by default. The clearest test: list what only that person did, and see how much of it has a deadline attached.
How quickly can an interim CFO start?+
Faster than a permanent hire, which is usually the entire point. A healthcare CFO search commonly runs several months from posting to start date once notice periods are counted. That gap is the problem an interim engagement exists to solve, and it is why the first conversation is normally about access, deadlines, and the close calendar rather than about strategy.
What does an interim CFO cost for a clinic?+
It varies with scope and hours, so anyone quoting a number before seeing your situation is guessing. The useful comparison is not interim versus fractional but interim versus the fully loaded cost of the permanent role, including benefits, payroll taxes, recruiting fees, and the months the seat stays empty. Our CFO cost comparison tool lays out the loaded-cost framework, and Sorso's ongoing fractional CFO engagements start at $4,000 per month.
Do we need an interim CFO if we already have an outside accountant?+
Usually yes, because they solve different problems. An outside accountant produces compliant historical statements. They are not monitoring your covenant tests, rebuilding your cash forecast, sitting in a payer negotiation, or answering a buyer's diligence questions about a two-year-old adjustment. Practices are often surprised to find how much of what the departing person did sat outside their accountant's scope entirely.
If the seat is already empty
The first conversation is short and concrete: what has a deadline in the next 30 days, what only one person knew, and what has to be covered this week. You will get a straight answer about whether you need an interim engagement at all.
Talk to us