The Lady Mountaineers have lost only six games against league opponents since joining the USA South Conference two seasons ago.
Four of those losses have been delivered by Piedmont College.
Berea College lost to the Lady Lions in the championship game of the USA South Tournament last season.
The rivals met again on Sunday with a title on the line, again.
The Lady Mountaineers (22-6) raced out to an early six-point lead, but Piedmont hit 32-of-42 free throws and claimed a third-straight USA South title with a 74-67 win in Demorest, Ga.
Bethanie Williams had 24 points, six rebounds and five assists as Berea College fell one game short of earning an automatic trip to the NCAA Division III Tournament for the second-consecutive season.
Bailee Vanover scored 10 of her 12 points in the first quarter to give Berea some early momentum. However, the Lady Lions led 18-16 heading into the second quarter and were up 28-25 at halftime.
Berea trailed 46-44 at the start of the fourth quarter before Piedmont went on a 7-0 run. The Lady Mountaineers battled back and got within two points (53-51) on a Williams layup with 5:19 left in the game.
The Lady Lions were able to seal the win at the free throw line. They connected on 15-of-22 attempts at the stripe in the final quarter.
Briana Lanham had 19 points and five rebounds for Berea. The Madison Southern graduate hit five three-pointers.
Kristin Barnes had five points and four rebounds. Kiley Barnard and Leah Parker each had three points, while Nakeisha Greene had one point and four rebounds.
The Lady Mountaineers shot 32.8 percent from the field, hit 8-of-22 three-point attempts and were 21-of-30 at the line.
Berea and Piedmont split the two regular-season meetings between the teams - which each winning on its home court.
The Lady Lions won 73-47 on Jan. 12 at home. The Lady Mountaineers picked up a 76-49 victory on Jan. 26.