This article introduces the first demonstration of integrating distance-based paper analytical devices (dPADs) with ionic liquid-based dispersive liquid-liquid microextraction (IL-DLLME) for the quantitative detection of bilirubin levels in human samples. In this approach, bilirubin is preconcentrated and extracted into a small droplet of the extraction solvent using IL-DLLME. The resulting solution is then introduced into an economical and straightforward dPAD sensor. Detection relies on a colorimetric reaction between bilirubin and gold ions (Au3+), leading to the in-situ formation of gold nanoparticles (AuNPs) on the paper substrate. The observed red-purple distance length is directly proportional to the bilirubin level. Under optimization, a linear range between 0.25 nM and 5.0 nM (R2 = 0.9979) and a detection limit (LOD) of 250.0 pM were achieved. The assay exhibits notable precision and selectivity without any interference. With its distance readout feature, this method is simpler and more cost-effective, offering greater sensitivity compared to other methods requiring expensive reagents and instruments. Moreover, the technique shows high accuracy and precision for bilirubin quantification in human control samples, with recoveries ranging from 98.33% to 102.00%. No significant difference was observed between our method and the enzyme-linked immunoassay (ELISA) method. By combining a low-cost microfluidic device with a simple microextraction method, this strategy holds great potential as an alternative analytical method for determining bilirubin. It can be expanded for further applications in analytical sensing for point-of-care (POC) diagnostics.