When Luke Spencer and Robert Scorpio traveled to Greece to stop Mikkos Cassadine from freezing the world they met Tiffany Hill. A beautiful B-movie actress, Tiffany was involved with Victor Cassadine, the evil Mikkos Cassadine's brother. After hearing Mikkos's plans to freeze the world, Tiffany helped Luke and Robert break into the command center. They destroyed the weather machine and Mikkos was killed in the process. Tiffany returned to Port Charles with her new friends and was part of Luke and Laura's spectacular wedding. Soon after, Tiffany asked Laura to come to New York with her.

Later back in Port Charles, Tiffany soon caught the eye of Dr. Noah Drake. Noah had been involved with Bobbie Spencer, but couldn't bring himself to commit to her. So she left town for awhile. That's when he began pursuing Tiffany. However, when Bobbie returned, Noah tried to get back together with her. When their romance failed once again, Noah bounced back to Tiffany. She got as far as his bed before deciding she didn't want to be with him. He ultimately left town.

Tiffany then began working for the Quartermaines following the murder of Alan Quartermaine. Sean Donely, who had been having an affair with Monica behind Alan's back, was the prime suspect in Alan's murder. Afraid that he would be sent to prison, he stopped seeing Monica. Sean had started to pursue Tiffany when the police arrested him for murder. Edward made a deal with Sean to have the murder charges dropped if he returned the money he had stolen while involved with Monica. Alan soon came back from the dead and Sean moved on from Monica with Tiffany. Tiffany began working for the television station WLPC as an executive and gave Colton Shore his own show called The Colton Connection.

In 1988, Tiffany and Sean finally made it down the aisle. During the ceremony, Tiffany's real name came out: Elsie Mae Crumholz. When the Cartel began working in Port Charles, they poisoned Tiffany in order to blackmail Sean into giving them information on Robert's investigation into the Cartel. The Cartel's evil plans eventually fell apart and Tony was able to cure Tiffany. When Tiffany's sister Cheryl died in a car accident, Sean and Tiffany went to Phoenix to get Cheryl's son Lucas. Lucas had once been adopted by Bobbie Spencer after Cheryl had been told her baby had died. Bobbie had discovered that Lucas was Cheryl's baby but didn't say anything so she could keep him. Cheryl eventually found out and got Lucas back. However, Cheryl left Lucas to Bobbie and Tony in her will, thinking Tiffany didn't want children. This infuriated Tiffany and she took Bobbie to court to gain custody of Lucas.

The custody battle threatened to tear Sean and Tiffany apart. She tried to fight dirty by telling the social worker about Bobbie's past as a prostitute. Sean refused to testify if Tiffany brought it up at the custody hearing. Despite his threats, Tiffany's lawyers used to ammo. Tiffany lost the case anyways and Lucas was given to Bobbie and Tony. Sean and Tiffany grew further apart and Sean had an affair with lawyer Jessica Holmes. When Tiffany discovered she was pregnant, Sean decided to go back to her. Jessica tried to stop him by claiming to be pregnant as well, but Sean returned to Tiffany anyways. When Tiffany found out that Sean might have gotten Jessica pregnant as well, she went into premature labor and her baby died. Devastated, Tiffany nearly committed suicide when Bobbie and Tony saved her. Jessica later retracted her pregnancy claim even though she actually was pregnant. When Jessica was murdered, Sean confessed to protect Tiffany because he thought she had killed Jessica. Felicia and Mac came to the rescue with proof that psycho Ryan Chamberlain was the murderer. Sean and Tiffany then began to repair their relationship.

When Luke Spencer shot Sean and badly wounded him, General Hospital recommended that they transfer him to another treatment facility in Boston. Tiffany discovered she was pregnant again just before the pair left town.

In 2013, Tiffany was referenced after Luke Spencer and Holly Sutton tracked Sean down in Ireland. Tiffany and Sean's daughter Anna revealed that Tiffany was in London seeking a cure for Sean's Polonium 210 poisoning.