Informed by the social cognitive theory and social exchange theory, this study examined medical coders’ evaluation of organizational cognition in the presence or perception of organizational support and organization engagement and their resultant behavior. The reciprocal exchanges present in the employee and organization relationship are identified, as positive valuations facilitate mutually beneficial outcomes. Specifically, the examination of cognitions, implicit employee judgments, and behaviors provide a framework to examine the state of engagement and its related outcomes. The use of perceived organizational support and organization engagement as intervening variables provided insight into the complex relationships between medical coding employees’ evaluation of organizational cognition and their exhibition of organizational citizenship behaviors in the context of U.S. healthcare. The a priori non-experiment survey design quantitatively examined the employee and organization exchanges that are implicit in the workplace and supported by theory and empirical research. This study found a statistically and practically significant effect for the higher order factor organizational cognition as intervened by perceived organizational support and organization engagement on the outcome of organizational citizenship behavior. The establishment of a multi-step intervening model highlighted the importance of the exchanges that are ongoing in an employee and organization relationship. In addition, examining perceived organizational support as a serial intervening variable with organization engagement provided a conceptual bridge beyond viewing the construct as just a resource. This study theoretically implies that perceived organizational support and engagement are inextricably tied, as the employee and organization relationship is facilitated by ongoing exchanges. Furthermore, engagement research modeling organizationally centric factors acknowledges the psychological valuations that employees undergo that influence behavior. Lastly, this study offers practical insight for promoting a supportive workplace environment that is distributively and procedurally just, offers growth opportunities, and has identified performance expectations. Medical coding employees who feel supported by the organization are more likely to be engaged and go above and beyond their assigned duties in the interest of themselves and the organization.

Date of publication

Summer 7-23-2019

Document Type




Persistent identifier


Committee members

Kim Nimon, Greg Wang, Drea Zigarmi


Doctor of Philosophy in Human Resource Development