The surface residual stress of the parts has an important influence on their performance. The generation mechanism of surface residual stress in ultrasonic vibration-assisted grinding (UVAG) of bearing steel was investigated, and the correlation between processing parameters and residual stresses was obtained. Based on the ultrasonic vibration-assisted grinding force and thermal model and the flow stress model considering the initial material microstructure, the mechanical and thermal stresses of the material were calculated. Finally, the theoretical model of residual stress is established based on the yield theory and experimentally verified. High-speed ultrasonic aerostatic spindle for ultrasonic vibration-assisted grinding, change the inlet pressure to realize the ultrasonic amplitude and frequency adjustment, the experimental results show that the cutting direction and the vertical cutting direction of the residual stress test results and the model prediction results of the average relative error of 11.4% and 11.7%, and the rule of change is more consistent. Based on the experimental results, the influence pattern of process parameters on the experimental results was analyzed. The results show that the residual compressive stress on the surface of ultrasonic vibration-assisted grinding is directly proportional to the grinding depth, feed rate, and inlet pressure of pneumatic ultrasonic wave, and inversely proportional to the linear speed of the grinding wheel. This study provides a theoretical basis for the analysis of UVAG residual stress and optimization of UVAG process parameters.