Smith was born as Hillary Bailey in Boston, Massachusetts. She attended Dana Hall School, Pine Manor College and Sarah Lawrence College. At Sarah Lawrence as a senior, she performed in off Broadway and Broadway productions, including The Heidi Chronicles. She married Philip Webster Smith, III in 1983. She met her husband at age 14 and married him a few years later after the two reconnected at a friend's wedding. They have two children, a daughter, Courtney and a son, Philip. (As an infant, Smith's son played her on-screen son briefly on As the World Turns.)
Smith is best known for her roles in the daytime soap operas. She made her soap debut in 1982, as Kit McCormick on The Doctors and one year later, taking over the role of Margo Hughes on As the World Turns, a role she played from 1983 to 1989.
After taking maternity leave from acting after the birth in 1988 of her son, Smith returned to daytime television, originating the role of Nora Hanen Buchanan on the ABC soap opera, One Life to Live. She played Nora from 1992 until the series' cancellation in 2012. She later returned to show in the 2013 The Online Network short-lived reboot. Smith won the Daytime Emmy Award for Outstanding Lead Actress in a Drama Series in 1994 for her performance in One Life to Live. From 1994 to 1995, Smith also has starred as lead in the NBC sitcom Something Wilder.

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